Facilities Use Application

	Name of Organization*

	Type of Activity Proposed*

	Specific Room(s) or Area for which application is made*

	Date(s) Facility is desired*

	Time requested:*
	Not before   and not later than

	Will Admission be charged?*
	Will Admission be charged?* YesNo

	If Admission is being charged, what amount?*

	President of Organization*
	Name   Street Address   City, State

	Person in Charge of Activity*
	Name   Street Address   City, State   Telephone/cell phone   Email

	Number of Persons Expected to Attend Please fax a roster, if one is available.

	Furniture or Equipment Requested Please be specific.

	Special Permission for:
	Decorating    Scenery    Piano    Microphone    Other, please specify

	Certificate of Insurance has been submitted to the Main Office
	Certificate of Insurance has been submitted to the Main Office YesNo

	The organization agrees to comply with the regulations for Use of School Facilities established by the Sea Girt Board of Education and to be responsible for any damage thereto. The organization president and individual in charge of the activity have read and will comply with the regulations.*
	The organization agrees to comply with the regulations for Use of School Facilities established by the Sea Girt Board of Education and to be responsible for any damage thereto. The organization president and individual in charge of the activity have read and will comply with the regulations.* YesNo