INSTRUCTIONS: PLEASE PRINT.
The applicant is to complete PART 1 and 2 and Part 3 (if applicable). Users requesting field use will receive an e-mail confirmation.
FEES: A $20.00 non-refundable processing fee must accompany this application. Please make checks payable to Bellevue School District
No. 405.
CANCELLATIONS: If a scheduled non-stadium field use is changed and/or cancelled, the user shall notify the Facilities Field Scheduler
or designee in writing thirty (30) days in advance of the scheduled change. To be eligible for a refund or fee adjustment, User must comply
with the required written notice.
AGREEMENT: By signing below, User/Applicant agrees to provide supervision/security for the requested dates indicated below. With
signature affixed below, user/applicant agrees that they have read and agree to the terms and conditions stated above and on the
Agreement.
ACCEPTANCE OF TERMS: Today’s Date:
The applicant (please print legibly) , a youth sports group, verifies that all coaches, athletes, and their parents/guardians,
have complied with mandated policies and laws that relate to the management of concussions and head injuries as prescribed by BH 1824, Section 2. Access to school
facilities may not be granted until all requirements of this application are complete and approved by the school district and/or designee. [Initial here ]
APPLICATION NO.
(to be assigned by BSD Field Scheduler)
FIELD USE APPLICATION
Bellevue School District
12037 NE 5
th
Street, Bellevue, WA 98005
PART 1 APPLICANT INFORMATION
Name or Organization: Contact Person:
Cell Phone: Phone (day): E-mail:
Billing Address: City: State/Zip Code:
Non-Profit? YES NO PRIMARY USE ADULT YOUTH
Unified Business Identifier (UBI) #:
PART 2 FIELD INFORMATION
School Requested (one location per form):
Field Choice:
Stadium
Baseball Field
Softball Field
Multi-Use Field
Purpose:
Baseball
Softball
Football
Lacrosse
Soccer
Track
Game
Practice
Other
Dates requested:
Hours requested:
Day(s) of the Week: M T W TH F SA SU
The following information is required for Field Use:
Total # Participants # Teams Ages % of BSD Students
Bellevue School District accepts the following forms of payment for processing fees and rental fees: Cash, Credit Card, and Checks
Please call the Facilities Office at 425-456-4500 for credit card payment over the phone.
Date: Date:
Athletic Director or Field Scheduler (Acknowledges receipt of application) Facility Use Approval (Event has been approved by the District)
Agreement to abide by Bellevue School District policy while using District Fields:
[please initial on the box provided on the left of each column, sign and date below]
Ensure that individual teams clean up the facility after each use, including dugouts,
scorers’ booths, athletic field, and surrounding area. Leave the field in better
condition than when you arrived.
The use of sharp objects or golf clubs on the artificial turf surface and track is
prohibited.
Please do not throw or hit into cyclone fencing or backstops.
Youth level baseball organizations are responsible for their own field lining and lining
supplies.
Bases may not be moved without prior authorization.
Shelled seeds and nuts are strictly prohibited.
Sunflower seeds are not allowed on the field or in the dugout.
Participants and officials must wear molded sole shoes or tennis shoes on the artificial
turf.
Dogs and pets are not allowed on fields.
No food or drinks other than water are allowed on the fields.
The pitcher on record will be the only one allowed to wear metal cleats ONLY
while pitching. He/She will remove metal cleats immediately after pitching.
Unsafe boisterious conduct, improper language and other objectionable practices will
not be allowed and must be controlled by user.
Alcoholic beverages or narcotics shall not be brought to or consumed on District
property. The use of tobacco is not permitted on District property.
Coaches for each team shall be responsible for communicating these rules and
regulations to all their coaches, team, and umpires.
Parking is not allowed on fire lanes. Your car will be towed or you will be
ticketed.
A Bellevue School District Field Monitor is on-site during field use. Please obey all rules administered by the
District Field Monitor. If any of the above rules are not met, the Field Monitor will stop this game/practice
and you will be asked to leave the field.
By my signature below, I have read the above terms and conditions and will abide by them.
Printed Name: Date
AGREEMENT (FIELD USE)
The Applicant hereby makes application to Bellevue School District No. 405, for the use of school fields described on the front of this
document and certifies that the information given in the application is correct. The signatory further states that he/she has the
authority to make this application for the applicant and agrees that the applicant will observe all rules and regulations of the Board of
Education and the Principals of the school in which the fields are requested. The applicant agrees to exercise the utmost care in the
use of the school premises and property and to save the Bellevue School District harmless for all liability resulting from the use of said
facilities/fields. The applicant further agrees to reimburse the Bellevue School District for any damage arising from the applicant’s
use of said fields.
Fees shall be determined by the latest rental rates. A $20.00 non-refundable deposit payable to Bellevue School District No. 405,
Bellevue, Washington is required at the time of application.
NOTICE TO USER OF SCHOOL FACILITIES:
Hold Harmless and Liability Insurance/Certificate of Insurance: A Certificate of Insurance and an Additional Insured
Endorsement Form, with Bellevue School District No. 405, its directors, officials, employees, and volunteers are to be covered and
named as an additional insured, on the Commercial General Liability policy with respect to liability arising out of the operations of the
insured. The policy must have ADDITIONAL INSURED provisions and be endorsed. The address to be noted on the certificate of
insurance should be 12111 NE 1
st
St., Bellevue, WA 98005.
The Certificate of Insurance should acknowledge the hold harmless agreement stated below and the liability insurance requirement
shall be provided to the District one week prior to the scheduled use of the field. User(s) shall agree to defend, protect, and indemnify
for costs, legal, and any and all other expenses or damages and to hold harmless the District, its officers, employees, agents, and
directors, from any and all claims, liabilities, or suits arising directly or indirectly out of user’s use of the synthetic fields, and related
or adjacent facilities. User(s) shall obtain liability insurance for no less than $1,000,000 combined single limit bodily injury and
property damage. Failure to provide this certificate shall result in cancellation of the field use and forfeiture of any deposit.
RULES AND REGULATIONS GOVERNING AFTER-SCHOOL USE OF FIELDS
1. Approval will not be granted for any activity which may in any way, be prejudicial to the best interest of the schools or for
which satisfactory and adequate adult supervision is not provided. This shall include proper police and fire protection where
necessary.
2. Participants and officials must wear molded soles shoes or tennis shoes on the artificial turf.
3. Metal cleats are prohibited on synthetic fields. Track spikes are to be limited to ¼” in length only and are limited to
and for use on the track, runways and high jump aprons. Only the Pitcher can wear metal cleats when pitching, when
at bat, he/she cannot wear metal cleats.
4. Substances which may stain the artificial turf or track, such as crepe paper, soft drinks, gum, coffee, Vaseline, candy etc.,
must be kept outside the playing area fence. Marking or painting on turf or track are prohibited.
5. The use of sharp objects or golf clubs on the artificial turf surface and track is prohibited.
6. Only participants (coaches, players or officials) are permitted inside the playing area fence. This includes the track and field
area.
7. Cheerleaders may use team run-through signs. However, such activity is limited to the blacktop area in the end zone only.
8. Dogs are to be leashed at all times and are not permitted on the fields (baseball/softball field, multi-use field, stadium,
track, batting cages). Owners must clean up after pets.
9. Only authorized maintenance vehicles are allowed on the track or artificial turf.
10. Motorbikes are to be parked in the parking lot only.
11. Parking is not allowed on fire lanes. Your car will be towed or will be ticketed.
12. The following are examples of activities not permitted within the perimeter of the facility: Bicycle riding, bringing animals
into the bleachers or on the fields and skateboarding or roller skating.
13. Unsafe boisterous conduct, improper language and other objectionable practices will not be allowed and must be controlled
by user.
14. Alcoholic beverages or narcotics shall not be brought to or consumed on school property. The use of tobacco is not permitted
on school property.
15. Kicking or bouncing balls against the fence, grandstands or any standing structure is prohibited. Do not throw or hit into
cyclone fencing or backstops. Lacrosse wall ball is strictly prohibited on school grounds.
16. Burning material of any kind is prohibited within the complex.
17. No signs are to be brought into the complex, without prior approval. Approved signs may be posted with District rules.
18. If a scheduled non-stadium field use is changed and/or cancelled, user shall notify the District’s Field Use Scheduler or
designee in writing, thirty (30) days in advance of the scheduled change.
19. It is the applicant’s/users/organizations responsibility to communicate these rules and regulations to all their coaches
and opponents.
Failure to comply with any of the above Rules/Regulations shall result in cancellation of this Field Use.