Longview Public Schools Facility Use Application - Non-Sports

Required

Applicant Information

Applicant Namerequired

First Name

Last Name

Daterequired

Must contain a date in M/D/YYYY format

Organizationrequired

Phone required

Email Addressrequired

Facility Requestedrequired

Room/Spacerequired

Purpose of Usage required

Start Daterequired

Must contain a date in M/D/YYYY format

End Daterequired

Must contain a date in M/D/YYYY format

Start Time/End Time required

Approximate Number of Attendees:

Youthrequired

Adultsrequired

% of Youth that are Longview Public School Studentsrequired

Additional Notes/Requestsrequired

Gyms will close early in middle school and high schools for cleaning of wooden floors 2 days per week.

Buildings schedule accordingly in middle school and high school to allow usage to end by 8:00 pm 2 nights per week.

This is an application only. Reservations are confirmed when all signatures and proof of insurance are received. The user accepts full responsibility and agrees to hold the school district harmless for any injury to persons or property resulting from this use.
School Facilities are primarily for school activities. Rescheduling may sometimes be necessary to accommodate school events.
Users are responsible for their own set-up and must leave the facility as found, to avoid additional fees.
Facilities used shall be limited to those specified on the application. Custodians/Other Staff do not have the authority to permit the use of facilities or equipment not indicated on the application.
Adequate child and event supervision must be provided by the applicant. This shall include proper police and fire protection when necessary.
The applicant agrees to reimburse the Longview School District for any damage arising from the applicant's use of the facility.
Special provisions will not be made for electrical power for applicants.
Park in approved areas only, Do not block fire lanes.
State law prohibits firearms, all forms of tobacco use, illegal drugs, or the consumption of alcoholic beverages in school buildings or grounds, including parking lots.

Compliance Statement for HB 1824, Youth Sports‐Head Injury Policies, and SB 5083, Sudden Cardiac Arrest Awareness.

Name of Group: required

requests the use of the (name of facility)required

in the Longview School District facilities for the following dates:required

Name of Grouprequired

, a private non‐profit group, verifies all managers, volunteers, coaches, athletes, and/or parents/guardians of children/athletes have complied with mandated policies for the Management of Concussions and Head Injuries as prescribed by HP 1824, section 2, and Sudden Cardiac Arrest Awareness as prescribed by SB 5083, section 3.

Signature (Representative of Private Non‐Private Group) with Date required

Longview School District, 2715 Lilac St., Longview WA 98632 must be listed as the certificate holder and additionally insured for your application to be processed.

Please attach proof of insurance under an accident and liability policy issued by an insurance company authorized to do business in Washington State covering General liability of limits of at least $1,000,000 Per occurrence for bodily injury and property damage, $1,000,000 Personal injury, $2,000,000 Annual aggregate limit.

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Note: Access to school facilities may not be granted until all requirements of this application are complete and approved by the school district &/or designee.