Facility Use Request Form

* Required

To the extent permitted by law, the Permitted User hereby agrees to protect the Town of Burlington, including the Burlington Public Schools ("Town") and its successors, departments, officers, employees, servants, attorneys and agents against any claim for damages, compensation or otherwise arising out of or resulting from any injury to any party in connection with said participation in the aforementioned rental of Town property and to INDEMNIFY, reimburse or make good to the Town or its successors, departments, officers, employees, servants and agents any loss or damage or costs, including attorneys' fees, which the Town or its representatives may have to pay if any litigation arises from said participation in the aforementioned activities. Permitted User further agrees to use and occupy the rented Town property at its own risk, and the Town of shall not be liable to Permitted User for any injury or death to persons entering the fields pursuant to said rental, or loss or damage to vehicles, equipment, structures or other personal property of any nature whatsoever of the Permitted User (or in the care, custody or control of Permitted User), or of anyone claiming by or through any of them, that are brought upon the rented Town property pursuant to the rental agreement, except if such injury, death, loss or damages is caused by the willful act or gross negligence of the Town, or its employees, agents, contractors or invitees.

All parties requesting rental of a school building, with the exception of school committee sponsored events, are required to furnish proof of liability insurance with a minimum $1,000,000 each event/$2,000,000 general aggregate limits for general liability that includes bodily injury and property damage naming the Town of Burlington as the certificate holder.

NOTE

[ 1 ] Sufficient time must be allowed
at the conclusion of the event to permit custodial staff to remove equipment
and clean.

[ 2 ] All fees are due one week prior to scheduled event.

[ 3 ] Cancellation must be made at least 24 hours prior to event or custodial fees of two hours per man will be charged.

[ 4 ] Event Application MUST be
submitted at least two weeks prior
to requested date.

[ 5 ] All rental customers MUST supply their own lighting and sound equipment. All equipment MUST meet local and state building and fire codes. All equipment must be UL listed. All equipment MUST
be listed on the application.
The Burlington School Department assumes no liability for the equipment supplied by the leasee.

[ 6 ] Nothing shall be attached or placed on floors, walls, furniture ordoors without permission from the Building & Grounds Department.

[ 7 ] THE USE OF SCHOOL FACILITIES IS SUBJECT TO EXISTING POLICIES AND REGULATIONS OF THE BURLINGTON SCHOOL DEPARTMENT, THE SCHOOL DEPARTMENT RESERVES THE RIGHT TO CANCEL ANY CONTRACT.

Facility Use Request Form

First Name*required

Last Name*required

Organization

Title Of Event

Email *required

Phone*

Type Of Activity*

List Other

Date Picker*(mm/dd/yyyy)

Activity Start Time*

AM   PM

Activity End Time*

AM   PM

Select School Location*

Expected Attendance*

Area Requested*

If you need to request multiple areas please list them below

Custodian*

Yes

No

2nd

Custodian*

Yes

No

Custodian Start Time*

Custodian End Time*required

Audio Visual Worker*

Yes   No

Cafeteria Worker*

Yes   No

Equipment Request

TABLES*

Yes

No

CHAIRS*

Yes

No

PODIUM*

Yes

No

Any Additional Information about your event:

Please send a confirmation email to the address below:



Security Measure