JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Facility Request Form
If your organization would like to use ISD 199 facilities, please fill out this form.
Please fill out this application at least three weeks prior to the first date of requested use. This application does not guarantee your reservation. When confirmed by our office, a building permit will be sent to you. (insert link to general rules and regulations)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
REQUESTOR INFORMATION
Organization name
*
Your answer
Customer Type (check all that apply)
*
Community Youth Organization (More than 90% of participants reside in IGH)
Youth Organization (Less than 90% of participants reside in IGH)
Non-Profit Organization
For Profit Organization
Required
Contact person/responsible adult (21 years or over)
*
Your answer
Email Address
*
Your answer
Mailing Address
*
Your answer
Phone 1:
*
Your answer
Phone 2:
Your answer
EVENT INFORMATION
Activity/Event Name
*
Your answer
Number of people participants (total)
*
If unsure, please give estimate
Your answer
Building
*
Hilltop Elementary
Pine Bend Elementary
Salem Hills Elementary
IGH Middle School
Simley High School
Required
Location/Room(s)
*
Your answer
Is this a recurring or one-time event?
*
Recurring
One Time
Please list specific dates/times requested below
Your answer
Do you require additional set-up/clean up time?
*
Yes
No
If so, please list that detail below
Your answer
Please give a brief description of set-up
Your answer
Please provide the exact timings (Start and End time)
*
We cannot complete your request if you would not provide the exact timings.
Your answer
Will you require any equipment set up?
*
(Chairs, tables, audio-video equipment, gym equipment, nets, flags, etc)
Yes
No
Will you be selling Concessions: (MDH license is required)
Yes
No
Clear selection
If so, please list those needs below
Your answer
Will you need access to the kitchen?
*
If you plan to serve food from our kitchen area, we require a food service employee to be present (to be paid for by user organization)
Yes
No
If requesting the Boche Memorial Stadium, will you require a stadium supervisor?
*
Supervisors are required for games with spectators, or events where the scoreboard/PA system will be used
Yes
No
REQUIRED PAPERWORK
Required Certification of Liability Insurance
*
ISD 199 requires this for those Class III, IV and V applicants. NOTE: A permit will not be issued without proper insurance coverage. Please contact
pierceb@isd199.org
for questions regarding this
Emailed to
khatoons@isd199.org
On file with the Community Education Office
Will be mailed
ELECTRONIC SIGNATURE
We agree to abide by the Facility Use Policy of Independent School District 199. Users are responsible for adhering to Policy 902 in its entirety; copy available on district website or by calling Community Education, 651-306-7870. By providing an electronic signature I agree to abide by the above.
Electronic Signature of a Responsible Adult
*
Your answer
Date
*
MM
/
DD
/
YYYY
Time
:
AM
PM
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ISD 199.
Report Abuse
Forms
