Code No. 903.1
Exhibit B
APPLICATION AND AGREEMENT
FOR USE OF
DECORAH COMMUNITY SCHOOL DISTRICT FACILITIES AND EQUIPMENT
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 use the facilities and equipment of the Decorah Community School District as follows:
Building:
Room(s)
Date: Time: From a.m./p.m. to a.m./p.m.
For the following activities (be specific):
Anticipated No. of Participants:
The adult sponsors are:
Check here that the adult sponsors understand they are responsible for ensuring compliance with Governor Reynolds’s current or future orders allowing facilities to open including: supervision of required capacity limits, supervision of required group size limits, supervision of required social distancing practices, and sanitization and hygiene requirements.
The organization desires to use the following District equipment and/or needs the following special accommodations (state any special tables, scoreboards, microphones, video equipment, extension cords, podiums, etc., needed):
Rental Fee: $
Building Supervision Charges: $
Custodial Charges: $
Food Service Charges: $
Other Charges: $ Specify:
Total $
All charges are payable in advance if requested. Make checks payable to the Decorah Community School District.
Payments must be made in advance: Yes _____ No _____
Check here if the organization is required to provide a certificate of liability insurance.
Check here if the certificate of insurance must include the District as an additional named insured.
I/We agree to be bound by the following conditions:
1. Availability of the facilities and/or equipment is contingent upon the activity in no way interfering with the District's educational and activity program. I/We understand that the District reserves the right without penalty (but with refund of the charges) to cancel any agreement to allow my/our use of the facilities and/or equipment.
2. The use of the facilities and/or equipment will not conflict with any laws or the policies, rules, or regulations of the District.
3. I/We will exercise care in the use of the facilities and/or equipment 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 activity will be constantly supervised by an adequate number of adult sponsors.
5. No alcoholic beverages, controlled substances, substance paraphernalia, or look-alike substances will be made available, used or consumed on the District grounds.
6. No smoking or use of tobacco products will be allowed on the District grounds.
7. Animals shall not be brought onto District property without permission of the District.
8. If a key is checked out, the person to whom the District checks out the key will be the first to arrive and the last to leave and will insure that all lights and equipment are turned off and the facility locked. The key will not be loaned to anyone and will be returned the next District business day.
9. The activity will be confined to the area approved and no school equipment or supplies will be used except as approved in advance.
10. The activity is not for a commercial profit-making venture or for personal financial gain.
11. If the facility being used is a gymnasium, all participants will wear gym shoes.
12. No District property shall be altered, moved or rearranged without District approval. All property of the organization must be immediately removed. All trash shall be properly disposed of in accordance with District directions.
13. I/We agree to provide an insurance certificate naming the District as an additional insured with the appropriate limits, if requested, in advance of the activity.
14. The District retains the right to access the facilities and to remove persons from District property.
15. 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 use of the facilities and/or equipment or arising from any activity thereon by the organization, its officers, agents or employees.
Approved:
_________________________________ ___________________________________
Representative Superintendent or Building Principal
Title:_____________________________
Date: ____________________________ Date:_______________________________
Copies to: Organization Representative
Superintendent/Building Principal
Head Custodian
Date of Revision: July 13, 2020
