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PCSD Facility Usage / Rental Request
* This form must be submitted and approved by the PCSD administration prior to consideration of Pleasantville Community School District facility use.
* Liability insurance may be required to rent PCSD facilities.
* Please allow at least two business days for a response to all facility use requests.
* All facility usage requests will be reviewed and approved by the AD and Superintendent.
Updated - May
, 2023
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* Indicates required question
Email
*
Your email
Required checklist prior to completing this form and submitting a request to use PCSD facilities.
LINK
to PCSD Facility Usage Guide
*
I agree to use PCSD facilities as outlined in the Board-approved facility usage guide.
I agree to the facility usage regulations & expectations as developed by the PCSD administration.
Required
Organization, group or individual responsible for rental
*
Your answer
Phone number
*
Your answer
Mailing address
*
Your answer
Based on your review of the PCSD facilities usage guide, which rental classification do you believe you fall in?
NOTE: The PCSD AD and Superintendent will make final determinations on facility usage classification decisions.
*
CLASS A: SCHOOL ACTIVITIES AND SCHOOL RELATED ORGANIZATIONS
CLASS B: PUBLIC AGENCIES AND LOCAL CITY PROGRAMS
CLASS C: LOCAL YOUTH AND LOCAL NON-PROFIT ORGANIZATIONS
CLASS D: LOCAL PRIVATE INTEREST GROUPS AND ORGANIZATIONS
CLASS E: OUT OF DISTRICT PRIVATE INTEREST GROUPS AND ORGANIZATIONS
Other:
What is the purpose of your facility rental / request?
*
Your answer
What PCSD facility are you requesting to use?
*
Your answer
What date(s)are you requesting the facility?
*
Your answer
What start time are you requesting the facility?
*
Time
:
AM
PM
What end time are you requesting the facility?
*
Time
:
AM
PM
Will you be serving food?
*
Yes
No
Maybe
Do you require use of any PCSD equipment?
*
Yes
No
Maybe
If you do require use of PCSD equipment, please describe (chairs, tables, sound system, projection system, podium, food service equipment, etc)
*
Your answer
FOR OFFICE USE ONLY (COMPLETED BY PCSD STAFF)
For office use only
PCSD Facility Assigned:
Rental Fee / Charge:
Other Fees / Charges:
Additional Staff Assigned:
Complaints, Damages, Problems, and/or Issues Reported:
Date Fees Paid:
Approved by AD:
Approved by Superintendent:
For office use only
PCSD Facility Assigned:
Rental Fee / Charge:
Other Fees / Charges:
Additional Staff Assigned:
Complaints, Damages, Problems, and/or Issues Reported:
Date Fees Paid:
Approved by AD:
Approved by Superintendent:
A copy of your responses will be emailed to the address you provided.
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