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804.6 Exhibit A Application and Agreement for Use of Unmanned Aircrafts on Decorah Community School District Property





Name of Organization:                                                                                                                         

Address of Organization:                                                                                                                     

Telephone of Organization:                                                                                                                 

Representative/Contact Person:                                                                                                            

Email of Contact Person:                                                                                                                      

Telephone of Contact Person:                                                                                                              

The above-named organization requests to operate an unmanned aircraft on the property of the Decorah Community School District as follows:


Date:                                                                     Time: From              a.m./p.m. to             a.m./p.m.

For the following purpose (be specific):                                                                                    


Type of Unmanned Aircraft:                                                                                                                

The organization desires to use the following District equipment and/or needs the following special accommodations:                                                                                                                              



I/We agree to be bound by the following conditions:

1.      Authorization to operate an unmanned aircraft on District property is contingent upon the activity in no way interfering with the District's educational and activity program. I/We understand that permission to operate an unmanned aircraft on District property lies within the discretion of the Superintendent or designee and that the District reserves the right without penalty to cancel any agreement to allow my/our operation of an unmanned aircraft on District property at any time.

2.      The operation of the unmanned aircraft will not conflict with any state or federal law or regulation applicable to unmanned aircraft, or the policies, rules, and regulations of the District.

3.      I/We will exercise care in the operation of the unmanned aircraft and agree to compensate the District for any damage done to the facilities or property of the District. The individual representative(s) agrees to reimburse the District in the event the organization fails to make reimbursement.

4.      The operation of the unmanned aircraft will be conducted or adequately supervised by at least one adult member of the organization.

5.      The operation of the unmanned aircraft will be confined to the area approved and no District equipment or supplies will be used except as approved in advance.

6.      No District property shall be altered, moved or rearranged without District approval.  All property of the organization must be immediately removed. 

7.      I/We agree to provide the District with proof of liability insurance that specifically includes coverage for aircraft/unmanned aircraft liability for the duration of this agreement with a limit of liability of no less than one million dollars ($1,000,000) per occurrence/claim. I/We agree to provide a certificate of insurance to the District and name the District as an additional insured on this policy.


8.      The District retains the right to remove persons from District property at all times.

9.      The representative and the organization agree to indemnify, save and hold harmless the District, its agents, employees, and officials from any and all claims or damages, including attorney fees and expenses, that may arise by reason of the organization’s operation of an unmanned aircraft on District property or arising from any activity thereon by the organization, its officers, agents or employees. 




_________________________________                      ___________________________________
Representative                                                              Superintendent


Title:  ____________________________

Date:  ____________________________                      Date: _______________________________


Copies to: Organization Representative

                 Superintendent/Building Principal