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.

[ 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 the event or the full amount of the custodial fees scheduled for the event 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 or doors 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.

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Email *
First Name & Last Name *
Organization & Title Of Event *
Phone Number *
Type Of Activity *
If you answered other, please write your type of activity here.
Date of Event *
MM
/
DD
/
YYYY
If multiple dates, please list here.
Activity Start Time *
Time
:
Activity End Time *
Time
:
How many people are you expecting? *
Select School Location *
Area Requested *
If you need multiple areas please list them below.
Custodian needed? *
Custodian Start Time *
Time
:
Custodian End Time *
Time
:
Cafeteria Worker Needed? *
AV Tech Needed? *
Equipment Request *
Required
Any additional information about your event.
A copy of your responses will be emailed to the address you provided.
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