Reif Center Facilities Use Form

Facilities Request Form

Date of Request

Requestor's Name

Organization/Group

Billing Address

City

State

ZIP

Phone:

Fax

Email:

On-Site Supervisor in Charge

On-Site Supervisor Phone

Activity Information:

Name of Activity

Event Days

Event Date/s

Event Start Time (indicate AM/PM)

Event End Time (indicate AM/PM)

Set-Up Time (indicate AM/PM)

Tear Down Time (indicate AM/PM)

Estimated Number of Attendees

Will admission be charged?

Yes No

Custodial Support Needs: (i.e. tables, chairs, etc.)

Audio Visual Needs

Comments and/or Special Arrangements

Conditions for Use

This application must be submitted 5 (five) working days prior to the date of use. Confirmation is not insured until you receive a copy of this application back. A signed and dated copy of his application must be with person(s) using facilities. The facilities may be closed on days when school has been closed for an emergency. If a fee is charged, a bill will be provided with the return of this application. A billing statement will be sent after the event, which will reflect the actual use of the facility including any addition time incurred due to early arrival or extended use, set up and/or clean up time, equipment rental, lab fees, etc. In some cases, advance payment may be request.

Responsibilities of Adult On-Site Person in Charge:

If you have questions concerning your reservation, contact John Miller at JohnMiller@reifcenter.org

Supervision of all persons using the area requested. On-site adult person in charge must stay on site until all students have left. Unsupervised student(s) is not allowed before or after scheduled activity. Supervision of student(s) is required or student(s) must leave the building and return when activity is supervised. That persons using the area requested remain in that assigned area. That the area and equipment be used in safe and reasonable manner. Counters and tables must be wiped clean (especially food, juice and markers). The room should be left in the same condition it was found. Turn off all electrical equipment, close all windows and lock doors before leaving. Report any injury to persons under your supervision to the Community Education Department at 327-5730. Report all breakage or damage to building or equipment to the Community Education Department at 327-5730. The adult person in charge will be responsible for any and all damage to building or equipment that is incurred as the result of inadequate supervision or improper use. The adult person in charge will be billed for the cost of repairs or replacement. A police person or liaison officer must be present at all student dance.

* Indicates Required fields.

Facilities Request Form

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