Requester Name
Requester Phone Number
Name of Organization/Club/Group or Meeting Type
Grade or Age Level
Type of Event
Number or Participants (excluding coaches, leaders)
Will specatators be attending this event?
Day and Dates of Usage
Time of Event (include a.m. or p.m. and include start and end time)
Additional Set-up Time (include before and after set-up time) If you don't require any before or after event time, please note: None
Facility Requested (only choose those you intend to use)
Other Room (Not Listed) Request
Additional Services Requested
Additional Comments
Do you have a Somerset School Distict Staff member available to open and close the building(s) and take responsibility for clean-up of the building(s)?
If no, a charge of $28.00 per hour (minimum of 2 hours) will be charged for custodial at the end of your event during non-school days.
If yes, please provide their name
Are You Collecting A Fee?
If Yes, amount?
Are You Charging an Admission Fee?
If Yes, Amount?
Are You Paying Wages?
Somerset School District staff supervision or custodial staff supervision at a rate of $28.00 per hour is required on all non-school days.
This form is only for requesting a facility. Filling out this form doesn't not reserve the facility. If your request is granted you will receive a contract confirming your request and any associated fees.
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