BOE Property Request Form

WATERFORD RECREATION AND PARKS COMMISSION    
  Revised 7/10/2022 
Property Use Request for Waterford School Facilities/Fields 
 
Today’s Date: ___________ Date Requested: ___________ Group Requesting Use of Facility: ______________________ 
Name of School: __________________________________ Which Room (s): ___________________________________ 
Day of Week: ______________________ Time of Day: From (include set-up) ______________To:__________________ 
Purpose of Use: _____________________________________________________________________________________ 
Participant Attendance Expected Per Session: ______________ Spectator/Attendance (if applicable) _________________ 
Special Equipment or Considerations Requested (please be specific): __________________________________________ 
Specify Handicapped Needs (please be specific): __________________________________________________________ 
*** If using the Waterford High School Swimming Pool, all people must know how to swim or be in a lifejacket and one on 
one with a swimming adult. *** 
 
 
 
Name of Adult Responsible for Activity: ________________________________________________________________ 
Address: __________________________________________________________________________________________ 
Phone: ______________________________________ Email: _______________________________________________ 
Additional Adult Supervisors: _______________________________ Phone: ___________________________________ 
Name of Sponsor (if applicable):_______________________________________________________________________ 
Sponsor Address: _____________________________________Phone: _______________________________________ 
Signature of Sponsor: _______________________________ E-Mail:_________________________________________ 
 
 
 
INSURANCE COVERAGE: All individuals/organizations, or in cases of public entertainment which are not town functions, the user 
shall present a certificate of proof of liability insurance coverage for the dates and times to be used in the amount of $1,000,000.00  
naming the Town of Waterford as an additional insured. In addition, the user may be required to present a security deposit in the 
amount of $1,000.00 or a determined portion there-of. In lieu of a security deposit, the user may present a certificate of property 
insurance naming the Town of Waterford as additionally insured. In the event the user’s property insurance has a deductible, the user 
shall provide a security deposit to cover the difference between the deductible and $1,000.00 or a determined portion there-of. Upon 
completion of use, security deposits shall be returned in full, if there are no damages. If there are damages, the security deposit shall 
be used to offset the actual costs of repairs.  All security deposits, when required, shall be in cash or by bank or certified check.  
Checks shall be made payable to the Town of Waterford.  It is recommended that Waterford Residents reserving/renting town 
fields or facilities consider purchasing insurance also because they are not covered under the town insurance and are 
responsible for any damage, injuries, or deaths that may occur to the people involved in their function whether participating 
or being a spectator. 
 
 
 
AGREEMENT: It is understood and agreed that by signing this agreement, the undersigned and/or represented group will adhere to 
the policy and regulations of the Board of Education and the Town of Waterford as stipulated in FORM RP, “Rules and Regulations”. 
The undersigned further understands the Town of Waterford and Board of Education are not responsible for any claims now or in the 
future the undersigned does have sufficient insurance in their name so as to guarantee this.  The undersigned agrees that the Town of 
Waterford and its’ agencies are held harmless from any such claims or damages and agrees to indemnify the Town in the event of any 
such claims or damages. I, the undersigned, understand that false or misleading information does not absolve my responsibilities. 
 
 
Signature: __________________________________________________ Date: ________________________ 
 
 
 
 
The Board of Education Policy, #4110/4210, prohibits smoking within school buildings and on school grounds.  This policy is 
uniformly and aggressively enforced.  It is the responsibility of all facility user groups to strictly adhere to this policy.  Failure to 
comply could result in the assessment of a fee to hire a monitor or denial of use of the school facilities in the future.