School Facility Rental Form (DOCX)

WATERFORD RECREATION AND PARKS COMMISSION
                                                             Revised 1/28/13

         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:_______________
How Many Weeks (Dates): _________________________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):
______________________________________________
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 Resident 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, 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.
** If using the Waterford High School Swimming Pool, I understand that 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 (Home):______________________Business:
________________________Cell:____________
Other Adult Supervisors:_________________________________
Name of Sponsor (if
applicable):___________________________________________________________
Address: _____________________________Phone:________________________
Signature:___________________________Signature of
Sponsor:_____________________________
E-Mail:_______________________________________

Fees: ________________________________/_______________________________
Paper work and fees must be paid by: ______________________________________
-----------------------
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