Principal S Report on Damage Or Abuse of School Facilities (Supply Details Below.)

Form 548-1 School Use/Rental Application AP 548 Community Use of School Reference Facilities Box 700, Rosetown, Sask., S0L 2V0 Revised December 18, 2014 Phone: (306) 882-2677 Fax: (306) 882-3366 Level School/Division Toll Free: 1(866) 375-2677, www.sunwestsd.ca Submit to Principal and Facilities Supervisor When Each Application

School Name Date of Application Name of Organization Box Number Town Postal Code Name of Responsible Adult Supervisor Name of Contact Person (if other than adult supervisor) Contact Home Phone Contact Cell Phone

Type of Activity Planned Date(s) Required Time Required to

Area(s) of School Required (Specify by name or number)

Arrangement of Furniture

Equipment Required

Caretaking Services Required

Insurance I have read and acknowledge the following statements and provided all contact information requested: The school division liability insurance only provides coverage for school-sponsored events. The school shall not be liable or in any way responsible to the renter in respect of any injury, loss or damage to persons or property occurring on the premises to the renter. It is recommended that organization(s) attain general liability insurance of at least ($2,000,000), particularly those involving high risk activities (i.e. gymnastics, martial arts, dance, fitness clubs, etc.) Alcohol and tobacco products and firearms are not permitted on school property.

Applicant’s Signature Date

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Refer to Administrative Policy 548 Community Use of School Facilities. Rent is to be determined in accordance with School Community Council established rates and Administrative Procedure 505 – Appendix A – Fee Schedule for area(s) and equipment as specified on application or as agreed to as follows:

Costs to User Regular Classroom $ Specialized Classroom $ Lab $ Gymnasium $ Caretaking $ Equipment $ Total (Make cheque payable to SCC) $

Principal’s Signature Date

Principal’s Report on Damage or Abuse of School Facilities (Supply details below.)

Principal’s Signature Date

Receipt for rental payment issued (if applicable) Rental fee remitted to School Community Council Treasurer (if applicable) Copy provided to rental group Copy provided to caretaker Copy provided to Facilities Supervisor Caretaking fees collected have been forwarded to the Facilities Supervisor (if applicable) Copy provided to School Community Council Renter has acquired liability insurance (copy provided)

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