Facility Rental Info - Northside Independent School District

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Name A School

Request for Community Use of District Facilities

Organization Information

Name of Organization:
Home Phone:		Work Phone:
Mailing Address:
City:
State:	TX	Zip Code:
Type of Organization:	Non-Profit Profit
Liability Insurance:	Yes No (A copy of insurance policy is required. Please submit.)

Facility Request Information

Date(s):
Site Requested:
Facility:
Age Group:		Estimated # of Persons (include both Participants and Audience):
Day(s) of the week requested:	Mon Tue Wed Thu Fri Sat Sun
Time(s) requested:	From To (Must include set-up and clean-up time.)

Total Rental Hours:

Please describe the nature of the activity:

Does this activity serve current NISD students?	Yes No		Approximate percentage of NISD students? %

Certification

By completing the fields below and submitting this application, I certify I am an authorized representative of the organization named in this application and the information and statements included herein are true and accurate to the best of my knowledge.

Full Name of Authorized Representative:
Email Address of Authorized Representative:
Title of Authorized Representative: