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

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FACILITY USE REQUEST FORM - COMMUNITY UT DOOR (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: 3
/26/2019
FACILITY USE REQUEST FORM - COMMUNITY
O
UT
DOOR 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 di
st
rict policy KF – Use of District Facilities,
Facility Use Guidelines (Community), B
ui
lding Rental Fees, and Personnel Fees for additional details.
Date: _________________________
Re
que
ster 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:
Port-o-Lets (Quantity) ___________________________________________
Required for events over 3 hours, events larger than 50 people, or by request
Trash Dumpster _______________________________________
First Choice of Location
Location: ______________________________________ Space(s) Requested: __________________________
Start T
ime: ____________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 Tuesda
y Wednesday Thursday Friday Saturday
Reset Form
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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: 3/26/2019
Second Choice of Location
Location: ______________________________________ Space(s) Requested: __________________________
Star
t T
ime: ____________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 Tuesda
y 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: __________________________
Star
t Date
: ____________End Date: _______________
To Be Held: Weekly Bi-Weekly Monthly Other (List): _______________
Day(s) Held: Sunday Monday Tuesday Wednesday Thursday Friday Saturday
Setup Instructions or Additional Information:
For outdoor events, please note the following:
• Food, sunflower seeds, nuts or gum are not allowed on synthetic surfaces
• Inline skates, skateboards, bicycles, or motorized vehicles are not permitted on any synthetic surface or turf field;
lawn chairs are not permitted on synthetic turf or running track surfaces
• Unauthorized snow removal is prohibited on any synthetic surface or turf field
• Glass containers are not allowed on any synthetic surface or turf field
• Prior to securing tents or other structures with stakes, the user must notify Colorado 811 three business days prior
to the event so all underground utilities can be marked; tents or other structures are not allowed on synthetic
surfaces
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FACILITY USE REQUEST FORM - COMMUNITY UT DOOR (Poudre School District)

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Completed 14 June 2021

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