Welcome to Cassadaga Valley Central School - District Building Use Form

District Building Use Form

11.21.09

Cassadaga Valley CSD
Building Use Form

[Visitor Login]

Items denoted with a red asterisk * are required.

* Submitted by

First Name / Last Name

* Location

Please select a location.

* Main Contact Number

- -

Secondary Contact Number

- -

* Requestor's Email Address

* Name of Organization

* Activity to be Held

* Please specify the room or location you wish to reserve.

* Date

* Start Time

(hh:mm am/pm)

* End Time

(hh:mm am/pm)

* Non Profit or Profit

Non Profit
Profit

Special Arrangements

* Will Admission be Charged?

Yes No

* Donations collected or funds raised? If yes please explain.

Yes No

Explanation of Funds Raised

* Do you have liability insurance?

Yes No

* If you do have liability insurance, please indicate the amount.

* Name of the Organization's Representative

* Representative's Mailing Address

* Representative's Phone Number

- -

* Person in Charge of Activity

By submitting this electronic form I understand that our organization assumes responsibility for the proper care of the facility and equipment during use and for damage andlor loss occurring during our activity. I further understand that the cost of supervision, custodial or kitchen service beyond the normal school provisions will be borne by our organization. It is understood our organization assumes any and all risk with respect to such access and use, and hereby release the Cassadaga Valley Central School District, its representatives, agents, servants and employees from liability for any injuries sustained, or damage incurred in the course of such access and use resulting from any cause whatsoever which may be sustained.