Fillable FACILITY USE REQUEST FORM - COMMUNITY INDOOR FACILITY (Poudre School District)

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FACILITY USE REQUEST FORM - COMMUNITY INDOOR FACILITY (Poudre School District)

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Customer Support Center
Poudre School District
2445 LaPorte Avenue
Fort Collins, CO 80521
Phone: (970) 490-3333 | Fax: (970) 490-3110
csc@psdschools.org
Customer Support Center Updated: 9/18/2017
FACILITY USE REQUEST FORM - COMMUNITY
INDOOR FACILITY USE
Fill out the following information and submit request to the Customer Support Center. Submission of request does not guarantee
approval; reservation will not be confirmed until the Facility Use Permit and Acknowledgement of Receipt is received. Please allow
10 business days for processing. See district policy KF – Use of District Facilities,
Facility Use Guidelines (Community), Building Rental Fees, and Personnel Fees for additional details.
Date: _________________________
Requester Name: _________________________________Email Address: _________________________________
Organization Name: _____________________________________________________________________________
Daytime Phone: ______________________________Evening Phone: _____________________________________
Billing Address: _________________________________________________________________________________
City: _____________________________State: _______________ Zip: _____________
Event Description: ______________________________________________________________________________
Age Group: Pre-K-12
th
Grade Adult Number Attending: _______________
Liability Insurance: Yes No
Note: All user groups must submit a certificate of insurance with this application. Additional information regarding insurance requirements and
options for obtaining insurance can be found at http://www.psdschools.org/department/building-rental.
Equipment and Service Needs:
Chairs ______ Other____________________________________________________
Quantity Please specify
Tables ______
Quantity
First Choice of Location
Location: ______________________________________ Space(s) Requested: __________________________
Start Time: ____________End Time: ______________ __________________________
Date (if one day only) ___________________________ __________________________
Complete the following if request is for multiple dates: Other: __________________________
Start Date: ____________End Date: _______________
To Be Held: Weekly Bi-Weekly Monthly Other (List): _______________
Day(s) Held: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
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Customer Support Center
Poudre School District
2445 LaPorte Avenue
Fort Collins, CO 80521
Phone: (970) 490-3333 | Fax: (970) 490-3110
csc@psdschools.org
Customer Support Center Updated: 9/18/2017
Second Choice of Location
Location: ______________________________________ Space(s) Requested: __________________________
Start Time: ____________End Time: ______________ __________________________
Date (if one day only) ___________________________ __________________________
Complete the following if request is for multiple dates: Other: __________________________
Start Date: ____________End Date: _______________
To Be Held: Weekly Bi-Weekly Monthly Other (List): _______________
Day(s) Held: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Third Choice of Location (if applicable)
Location: ______________________________________ Space(s) Requested: __________________________
Start Time: ____________End Time: ______________ __________________________
Date (if one day only) ___________________________ __________________________
Complete the following if request is for multiple dates: Other: __________________________
Start Date: ____________End Date: _______________
To Be Held: Weekly Bi-Weekly Monthly Other (List): _______________
Day(s) Held: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
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FACILITY USE REQUEST FORM - COMMUNITY INDOOR FACILITY (Poudre School District)

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Completed 14 June 2021

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