Name of Requester

Phone

Email

Name of Club/ Organization/ Activity

Date of Activity

Program Administrator

Secondary Contact

Secondary Contact Phone

Please briefly describe the activity below

Facility and Location

Time needed for facility

Start Time      AM     PM

End Time       AM     PM

Actual time of program

Start Time      AM     PM

End Time       AM     PM

Set-up needed ( If set-up is needed please fill out the sections below)

Time set-up is to be completed by      AM     PM

Time take down may begin      AM     PM

Please describe any special set-up instruction and list any equipment needed for your activity below

Please carefully read and agree to the terms and conditional statement below.

I agree and understand the condition that the final approval of my request for the use of WCSD facilities, staff, equipment, and any and all items that belong to Washington Colony School District is dependent upon submission of a copy of WCSD's Terms and Conditions Form with a valid signature of my organization's representative and a copy of my organization's current liability insurance to the Washington Colony School District's school office. I also understand that it is solely my responsibility to submit and obtain all requested and necessary forms, information, and valid signatures prior to the date for facilities, staff, equipment, and any and all items that belong to Washington Colony School District use.  

I accept the terms and conditions stated above.  I also agree and understand that I am responsible for obtaining all requested and required forms, information, and valid signatures before final approval of my request will be granted. 

Please use the links below to download the WCSD Terms and Conditions Form

WCSD Terms and Conditions - PDF

WCSD Terms and Conditions - DOC