Name of Applicant:
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Organization Name:
Address:
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City:
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State:
-- AL AK AZ AR CA CO CT DC DE FL GA ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY *
Zip:
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Home Phone:
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Cell Phone:
Email:
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Under which category does your group qualify?
-- School Team/Group (part of CE or Athletic Dept.) IN DISTRICT Non-School Team/Group (i.e., JO VB, DE Storm, Travelling Baseball, PATT, DEMA, Post Prom) OUT OF DISTRICT Team/Group *
If this is an non-school group, do you understand that there will be a fee associated with use of the facility?
Yes
No
I understand that the responsible party must have access to the building (fob/toggle fob, know alarm), must be in the area of the event at all times, and must not leave the building until all persons have left. It is further understood that on weekends, the responsible party must be available to unset the alarm when doors unlock, and set the alarm when the doors lock after the event.
Yes
No
I do not have access to the facilities and need a supervisor to be on site
Name of the responsible party:
Purpose of event: (be specific if a sport--i.e, 9th Gr GBB practice, RYSA, Jr. Olympic VB game, etc.):
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Estimated Number of Persons Attending
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Choose site desired:
-- Elementary High School Dover Building Eyota Bus Garage Sports Field Track *
List Room #, Gym (HS Courts 1,2,3 or EL), Area, or Athletic Fields being requested:
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Ball fields are only lined for games. You must specify game dates that you want the field(s) lined.
List all Dates:
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Set up time if different than start time:
Event Start Time:
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Event End Time:
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Take down time if different than end time:
Specify when doors are to be unlocked and locked. If you want to use the default time in which doors will UNLOCK 15 minutes before event/set up time and LOCK 30 minutes after the event BEGINS, type in "Default".
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I UNDERSTAND THAT I MUST BE AT THE BUILDING 15 MINUTES BEFORE THE EVENT in case the building alarm needs to be unset!
-- Yes No (If no, please contact Tara Dabelstein at 545-2125 or ) *
Which outside HS doors do you want unlocked? Indicate: HS Front, door #5 (by HS Fitness Center), or Elementary Main
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The district reserves the right to adjust the times the doors unlock and relock...please check the times provided when you receive your reservation confirmation.
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Do you already have access to equipment or setup?
Yes
No
If you need access to equipment or setup, how do you plan on getting access if not requesting it with this request?
List Special Requests below (TV/VCR, podium, microphone, addtl chairs/tables, volleyball standards/nets, sports equipment, etc.):
All concession stands fall under the Food & Nutrition Department and must follow county health department rules. Therefore, no foods prepared at home shall be allowed to be served in the designated concession stands or designated kitchen facilities of the school district. Details can be found in Policy 910 – Food From Home.
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Will food be served at this event?
Yes
No
If so, what type of foods will be served?
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Where will the food be originally prepared?
Not applicable because food will not be served
Foods prepared at home includes any food item prepared in any location other than the district Food & Nutrition facilities, and by anyone other than an approved professional vendor or a certified member of the district Food & Nutrition staff.
Purchased from a vendor licensed to prepare and sell food items
Purchased from the DE Food Service
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Will attendees be charged for the food?
Not applicable because food will not be served
Yes
No
This application is made subject to the rules and regulations of the school district, and the undersigned hereby agree for themselves and all others for whom this application is made, that the same are acccepted and will be observed. I have read the Dover-Eyota Public Schools Guidelines for Community Use of Public School Facilities and agree to comply with the Conditions of Use. NOTE : Rooms/Sites are to be left in the way you found them!! (#11 of “Conditions of Use”) The school district reserves the right to cancel any permit.
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I have read and accept all procedures, terms and conditions of this request form:
Yes
No
Additional comments, information or questions
