Building Use Application

Building Use Application



Application Date:

Name of group or organization: 

Non-Profit 501C(3) Number: 

Name of Applicant:    Point of Contact email:

Home phone:   Work phone: 

Purpose of Use: 

Access to rooms or areas of building will be limited to those listed below. Please be sure to list all areas of the building necessary for event (rest rooms closest to event will be accessible without listing):

Date(s) needed:     Day(s)  of week:   

Room(s) or areas: 

Arrival time:    Departure time:   

Event Start Time:    Event End Time: 

Certificate of Insurance  

(All equipment requested for use must be prearranged prior to event)

Equipment requested:

District designee responsible at event:  

Other possible requirements for event:  


Approximate number of adults anticipated for event: 

Approximate number of children anticipated for event: 

All scheduled use of facilities is subject to availability and may be canceled at any time due to requirements of the facilities for a school activity.

Indicate child care /supervision arrangements for children present:  

I understand that there may be fees charged for the event?   

Possible Fees assessed by district for event:

  • Space Use fee
  • Damage Deposit
  • Custodial
  • After hours access
  • Light/sound technician
  • Auditorium
  • Old Gym
  • New Gym
  • MPR
  • Classroom

The responsible party shown below shall be responsible for payment of all fees in advance and for compliance with conditions of use. To the fullest extent permitted by law, the above group agrees to defend, pay on behalf of and hold harmless the Gilpin County School District, its elected and appointed officials, employees and volunteers and others working on behalf of the Gilpin County School District against any and all claims, demands, suits, losses, including all costs connected therewith, for any damage which may be asserted, claimed or recovered against or from the Gilpin County School District, elected or appointed officials, employees, volunteers or others working on behalf of Gilpin County School District by reason of personal injury, including bodily injury and/or death; and/or property damage, including loss of use thereof, which arises out of the alleged negligence of the above- named group and/or in any way connected or associated with this contract.

Signature of Responsible Party    Date  

Security Measure
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