Facilities Use Request Form
(fill out this form and fax/send/drop-off using the information below)
SITKA SCHOOL DISTRICT
BOX 179, SITKA, ALASKA 99835
Community Schools Phone - 907-747-8670 / FAX 966-1462
FACILITIES USE REQUEST FORM
The undersigned requests the use of Sitka School District facilities under the terms and conditions stated and
on the dates and hours shown below.
DATE DAY OF WEEK BEGINNING ENDING
HOUR(AM/PM) HOUR
1. __________ ____________ ___________ ___________
2. __________ ____________ ___________ ___________
3. __________ ____________ ___________ ___________
PURPOSE_________________________________________________________________
ORGANIZATION MAKING
REQUEST:_____________________________________PROFIT_____NON-PROFIT____
Billing Address:____________________________________________________________
Will you be charging for this meeting/activity? yes___ no___ Fee:$__________
Estimated number of attendance:____55+ ____18-54 ____17 & below
Will you be bringing food or drink to this activity? yes____ no____
Equipment needed:__________________________________________________________
(Needs approval before meeting: white board/chalkboard, t.v. & vcr, etc.)
Representative's Name:_______________________________Title:___________________
Contact Phone_____________________________
I have read and understand the policy for room/gym use for the Sitka School District as set forth and will insure
that my group/organization will follow these rules.
Signature:______________________________________________Date:_______________
FACILITIES REQUESTED : CLASS ROOM
__Blatchley Middle School #__________
__Sitka High School #__________
__Verstovia Elementary #__________
__Baranof Elementary #__________
* TYPE OF ROOM NEEDED: Classroom Gym MPR Commons Concessions (please circle)
************************Office Use*************************
Facilities Fees_____________ Supvr. Fees____________ Custodial Fees__________
PAID CK# or $____________ Calendar________ Email__________ RM#_________
ETOLIN STREET GYM RULES
In addition to the standard Rules for School Use the following applies to Etolin Gym:
1. Adult supervision is required at all times.
2. Stay off the balcony.
3. Stay off the pull-out bleachers.
4. Do not block the fire exit doors; these doors, front and back, should be kept clear at all times.
5. When leaving, turn off all lights, EXCEPT the fire exit signs and the light over the breaker box.
6. Make sure that both the front and back doors are secured when you leave.
7. Use only equipment which you are authorized to use
8. Clean up any mess you make.
9. Report any problems, damage, or accidents to the Community Schools office immediately (747-8670).
10. Return the key promptly to Community Schools after use.
Sitka School District
Community Schools - Room Use Guidelines
Community Schools is pleased to be able to accommodate your request to use school facilities. To ensure that room
use goes smoothly for you as well as school staff, please make a note of the following:
1) Teachers empty their own garbage at the end of each school day. If you are bringing food or drink it must be
noted on the building request and be approved. If you bring food in the room or have any garbage, please bag it
up and dispose of it.
2) Teachers put the chairs up on the desks or tables at the end of the day. Please make sure the chairs are up
off the floor when you leave.
3) Do not use teaching supplies. This includes markers, paper, scissors, etc. Bring your own supplies with you.
4) Teachers may leave notes or assignments on their board. Do not erase board without teachers permission. Please
note on building request to use the white board, it must be approved in advanced.
5) Sitka School District property shall be returned to it's original condition after use. If you are doing arts
and crafts projects, cover the tables or wash them thoroughly. A minimum janitorial fee of $50.00 will be charged
if additional cleanup is necessary.
6) MPR: if you are using the chairs or the stage in the MPR. You will have to pick up a sheet on how to put the
chairs or the stage back, they both have to be put away a certain way to fit in their storage area.
7) The using organization will protect Sitka School District property from damage or mistreatment and is responsible
for the condition in which the building is left. In the event Sitka School District property is damaged, the organization
will be liable and charged for the cost of repairs.
8) The using organization agrees to hold the Sitka School District harmless and not responsible for any injuries
or property loss which may occur through any accident or theft during the use of the facilities.
9) Facilities use may be revoked by the District whenever that use could interfere with District programs. Facility
use will be denied to groups having violated these rules in the past.
10) Scheduling of any Sitka School District equipment does not imply the availability of such equipment. All requested
equipment must be checked out and returned at the Community School's office.
11) CHILDREN must be supervised at all times.
Thank you. Your cooperation is greatly appreciated. If you have any questions, please call Community Schools
at 747-8670.