APPLICATION FOR USE OF SCHOOL DISTRICT FACILITIES

McComb Local Schools 328 S. Todd St. McComb, OH 45858 Phone: 419-293-3979 FAX:419-293-2412

Today’s Date: ______________Date of Event: _____________ (If multiple dates are needed, use back side to list.)

Doors open at: ______________________a.m. p.m.	Doors Closed at: ______________ a.m. p.m.

Actual time of Event: ______________________________

Please Give a Brief Description of Purpose for This Event:

SPECIFIC NEEDS REQUESTED FOR THIS EVENT

Room(s) Requested: ______________________________________________________________________________

Doors to be unlocked (check all)	Door #1	Door #2	Door #3	Door #4	Door #5	Door #6	Door #7

Door #9	Inside glass doors	Inside cafeteria door

Equipment / Supplies / Furniture / Elevator Needed ____________________________________________________

Any Services Required Before/ During/ After Event _____________________________________________________

PERSON(S) RESPONSIBLE FOR THIS EVENT / CONTACT PERSON

Organization or Group Requesting Use ____________________________________________________________________

Name of applicant: _____________________________________ Phone # : (H) _______________________ (W) _______________________

Address: ______________________________________________________________________________________________

I (undersigned) agree to indemnify and hold harmless the McComb Board of Education, their agents and employees from all liability, claims,

demands, damages, or costs for and/or arising out of the use of their facilities as described herein, whether it be caused by the negligence of the

indemnitee or the McComb Board of Education or either party’s agents/employees or otherwise. The undersigned is responsible for any keys

obtained in this usage and for building security associated with this event. Furthermore, I understand and accept the criteria established for the use of

this building, the fees and charges associated with this use and the rules and regulations established for the proper care and return of the facility.

Signature of Applicant: ___________________________________________________	Date: _________________________ (Your printed name constitutes your signature)

REGULATIONS FOR FACILITY CHARGES

All groups will be required to leave a deposit which will be returned after the activity date if the facility is in the same condition as before used.

Current school affiliated groups are exempt from rental fees. If an activity is held during regular working hours and no additional changes or

personnel are required, there is no charge for using the facility. District resident non school affiliated groups will be charged a nominal usage fee

to cover utility and equipment costs and/or any personnel costs if needed. All non District residents will be charged a usage fee and any fees for

personnel costs as needed. (See back for schedule of fees) Costs of services required will be billed according to the adopted salary schedule of the

employee. I.e.: custodians, cooks, servers. Meal charges can be obtained from the cafeteria manager.

Athletic Director’s Signature

Student Activity Advisor’s Signature

Principal’s Signature

Superintendent’s Signature

_____________________________

_____________________________

_____________________________

_____________________________

Date ____________________________

Date ____________________________

Date ____________________________

Date ____________________________

Application Request Accepted _____	Application Request Denied _____

Copy To: Applicant ____Supt. ____ Principal ____ Athletic Dir. ____ Advisor ____ Custodian ____ Kitchen ____ Teacher ____

** A list of fees and deposits along with further directions may be found on the back side of this form.

RULES / REGULATIONS FOR USE OF FACILITIES

The McComb Local Schools allow for use of their facilities under the direction of Board Policy 7510 and the administrative guidelines contained on

this two sided sheet. Applications may be obtained from the Superintendent’s and any Principal’s. It is the duty of the individual signing the

agreement to be responsible for the facility use. Any misuse of privileges or abuse of the buildings will void the permit for future use. Care should

be taken with all property. Any damages will be repaired and a charge will be made to the individual or party using the facility at that time. A cook

will be required whenever the kitchen is used. While school activities are a priority, consideration will be granted to groups who have planned ahead

and are prepared to use the facility in advance. The McComb School District administration reserve the right to adjust the facility usage and fee

structure to meet need and circumstance. The required fee and deposit will be applied to each activity date as described in this application. Ongoing

activities may be subject to additional deposits as the initial deposit is used up. There will be no smoking or use of alcoholic beverages at McComb

School grounds or facilities.

SCHEDULE OF DEPOSITS AND FEES

The deposits and fees listed below are for facility use only. These do not reflect additional personnel costs related to supervision or operation of

facilities or equipment.

	FACILITY	

SCHOOL RELATED

	GROUP	

RESIDENT GROUP BUT

NON SCHOOL RELATED

NON RESIDENT

	GROUP	

DEPOSIT	FEE

Cafeteria(s) Only	$50	-0-

DEPOSIT	FEE

$100	$100

DEPOSIT	FEE

$100	$250

Kitchen Only	$50	-0-	$100	$100	Not Available

Cafeteria and Kitchen	$75	-0-

Gymnasium(s)	$50	-0-

H.S. Auditorium	$50	-0-

Classroom	$25	-0-

$150	$150

$100	$ 10

$100	$ 25

$50	$ 5

$150	$300

$100	$125

$100	$150

$50	$ 50

Estimated Amount of Charges for This Request:	Deposit Required __________________	Date Paid ____________

(Meal charges are NOT included in this estimate) Fees Charged

Personnel Costs

__________________

__________________

Date Paid ____________

Date Paid ____________

Total Estimate	__________________

(Includes Refundable Deposit)

Additional date of events:

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Adopted September 8, 1999	Revised 01/08/21