Bolivar-Richburg Central School
Request for Use of Buildings and Grounds


* Fields are required!
Organization: *
Person Responsible: *
IP Address:
E-mail: *Re-enter E-mail: *
Street Address: *
City: *Phone:
Zip: *Cell Phone:

Building Requested:*

Area Requested:*

Select Date(s) and Time(s):
Click on the graphic to the right of each field to display a calendar or time selector.

Start Date End Date
Start Time End Time
* *

Please explain what you will be using our facilities for.

Rates for Use of Facility
Established Community Organizations: No fee, use of lights limited to two events at no fee, thereafter $125 for the 1st hour and $30 per ¼ hour.
Out of district organizations: Use of facilities $100, use of lights $125 for the 1
st hour and $30 per ¼ hour thereafter.

Do you need any of the following additional equipment?
Use of the items below could involve additional charges.

Other Additional Equipment:

Insurance Information
Do you (the requesting organization) have a general liability policy? *
If yes, please include a certificate of insurance form from your insurance agent. Include Bolivar-Richburg Central School as certificate holder and additional name insured. ($1,000,000 minimum limit of liability required)

Attach file:

Requesters required to read Conditions and Regulations

I agree on behalf of the above indicated organization that all members and guests will observe the regulations linked above and that we, individually, and as an organization will assume full financial responsibility for any and all damages done to Bolivar-Richburg Central School property during the above indicated period of use. Our organization also agrees to hold harmless and indemnify the District to the fullest extent allowed by law for injuries or property damage caused by our use of the facilities.
I have read the Conditions and Regulations and agree to the above terms: *

Please print a copy of this request for your records!