Wayne Trace Local School   
4915 US 127
Phone: 419-263-2415				      Haviland, OHIO 45851	               Fax: 419-263-2377

REQUEST FOR USE OF SCHOOL BUILDING AND PERSONNEL SERVICES

******RENTAL RATES:	$ 40.00 – INCLUDES 1ST SPACE ( a space shall be defined as one of the following; cafeteria, gym, auditorium, etc)
				$  20.00 – INCLUDES EACH ADDITIONAL SPACE
				$  40.00 - PER HOUR ADDITIONAL IF CUSTODIAL SERVICES ARE NEEDED.
				$  30.00 – PER HOUR ADDITIONAL IF KITCHEN IS USED.

                                      ***Users shall be liable financially for damage to the facilities and for proper chaperonage.***

Today’s Date: _________________________	Date of 
Meeting:_____________	Group Requesting:_________________________________

Person making arrangements for the group:            Name: ________________________________________________________ 
                                
Address: _______________________________ City, State, Zip: ____________________________ Phone: _________________
	
Description of room(s) requested:

_______________________________________
	
Program time from :         ________________ to _______________

Building to be open from: ________________ to _______________

Kitchen or kitchen equipment needed? 

_________________________________

Number of persons expected to use facility: ___________________________

Any equipment needed? (projector,dvd,screen)________________________

________________________________________________________________	

Name, address and phone number of person or organization to be billed:                             Phone: ______________________

Name: ________________________________________ Address: __________________________________________________

City, State, Zip: ____________________________________               (COMPLETE AGREEMENT ON REVERSE SIDE)	
DECORATIONS WITH COMMAND STRIPS  - NO  TAPE, 
NO FORM OF ALCOHOLIC BEVERAGE OR TOBACCO PRODUCTS TO BE USED ON PREMISIS	
**********TO BE COMPLETED BY BUILDING OFFICE**********

ESTIMATE OF EXPENSES:

    $                                      Rental Fee                                                  $ ___________________ Kitchen Use
                                                                                                                                             ($30.00/hr. additional)
                         $ _________________ Custodian Rate                                            
                                                               ($40.00/hr. additional)                                                                          

                  DEPOSIT OF ____________________ REQUIRED BY ___________________
	
CONFIRMATION AND FINAL ARRANGEMENTS MUST BE MADE AT LEAST 3 DAYS PRIOR TO SCHEDULED EVENT. PLEASE CALL BUILDING SUPERVISOR  AT 419-263-2415.	

Signature of Building Principal: _____________________________________________

By state law any activity held in the Wayne Trace Local School facilities must be considered to be open to the general public. O.R.C. 3313.77 and 3313.81.

RENTAL AGREEMENT
WAYNE TRACE LOCAL SCHOOL
4915 US 127, HAVILAND, OH 45851

TO BE COMPLETED BY THE LESSEE	

The _______________________________ of ____________________________ hereby contracts for the 
          	(Name of Organization or  Individual)			(Address)

rental and use of the __________________________________ at  Wayne Trace Local School for the dates of 
     				(Room or Rooms)

___________________________ from ________________ to _______________.  
     	(Date)				 (Time)		       (Time)

Rules and regulations of the Board of Education shall apply. Lessee shall be responsible for any damage to the buildings, grounds, or equipment.
.

   The Lessee _________________________________ shall indemnity, hold harmless and defend the Lessor
 		        (Name of Organization, Individual)
(Wayne Trace Local School) its agents, employees and representatives from and against any and all claims, liability, damage or loss to person or property which may arise or grow out of the use of  the named facility by  the Lessee, or out of any act of the Lessee, Lessees employees, agents, invitees , licensees or hired service provider(s). “The Lessee shall carry general liability insurance covering the use of the facility with the Wayne Trace Local School Board of Education named as an additional insured. The general liability limits of liability shall be $1,000,000 per occurrence and $1,000,000 aggregate. A certificate of insurance (Special Event Endorsement) verifying such coverage shall be presented to the Building Principal of the Wayne Trace Local School prior to the event for which the facility has been leased.”  (MUST RECEIVE THIS W/BUILDING USE FORM 1 WEEK PRIOR TO EVENT)

This agreement executed and signed on ___________________________ at Haviland, Ohio.
      (Date)

______________________________________		______________________________________
             (Signature, Lessee)		        (Signature, Building Principal)

Rental 2/11/2016