Facilities Usage Application


Date of Application: 12-14-2017    Name of School:

Expected Attendance Count:

Facility Requested:

Equipment Needed:

Name of Program:

Type of Target Audience:

Appropriate Audience Age Range:

Educational Purpose of Program:

Websites Associated with Program:

Speaker or Performers:

All Other Information Necessary to Evaluate Program:

DAY DATE TIME(hh:mm)(select am or pm)
  to  
  to  
  to  

We hereby certify that we shall be personally responsible, on behalf of our organization, for any damage or abuse of school buildings, grounds, or equipment growing out of the occupancy of said premises by our organization. We agree to abide by and enforce the rules and regulations of Texarkana Independent School District governing the non-school use of buildings, grounds, and equipment as delineated in "Rules and Regulations for Non-School Use of School Property" found at the following link.

Facilities Usage Information Packet

We agree and undertake to save and hold harmless the Texarkana Independent School District from any and all claims for damages, personal or otherwise, that may arise out of the use of said property, whether by a member of our organization or by other person using or enjoying said property, and without regard to whether damage, personal or otherwise, is brought about or caused by the negligent operation of said property by us.

Name and Type of Organization (Service, Civic, Church, Educational, or Other. If Other, specify):


By checking you are electronically signing this application.
Name and Title of Authorized Agent Signature of Authorized Agent
 
How Sponsoring Organization will be identified in advertising and program:
 
Billing Address: Street Address:
  City: State: Zip Code:
 
Phone: Fax:
Mobile/Cell: E-Mail:
 
Drivers License State:    Drivers License Number:
License information is required for a possible criminal history background check.


Classification: ________________________________________  Fee Charged: $_____________
Approved (Principal or Administrator): ______________________  Date Approved: ____________

*The fiscal year for Theatre Rental is July 1 - June 30. Applications for each fiscal year will not be considered prior to June 1st before the start of each fiscal year.