ࡱ> AC@ @ $bjbjqq 7>DR.00000   RT  00 }}} 00}}}}0$ P.EM'v}$"0R}&&}&}T }}|$   s 鶹Ƶ City Unified School District (PSS- F003) RESERVATION REQUEST FOR THE SERNA CENTER COMMUNITY MEETING ROOM(S) MUST BE SUBMITTED AT LEAST 15 WORKING DAYS PRIOR TO REQUESTED DATES ROOM(S) REQUESTED:_______________________________________________________________________________________________________________________ DATES: STARTING: _______________________ ENDING:_______________________ DAY OF WEEK:____________________________________________________ SCHEDULE OF USE: SINGLE___________________WEEKLY__________________MONTHLY__________________ TIME: OPENING (Set-up time)_______________________________AM/PM CLOSING (Clean-up time)______________________________AM/PM PURPOSE: ___________________________________________________________________________________________________________________________________ EQUIPMENT REQUIRED, IF ANY: _____________________________________________________________________________________________________________ (Please make arrangement with custodian prior to event) NUMBER OF PEOPLE: _________________ SET-UP NEEDS:_______________________________________________________________________________________ REQUESTED BY: ______________________________________________________DAYTIME PHONE #____________________________________________________ DISTRICT BUDGET CODE# FOR CUSTODIAL/SECURITY FEES (if applicable)______________________________________________________________________ ADDRESS/SITE DEPARTMENT MAILBOX #_____________________________________________________________________________________________________ CITY, STATE, ZIP CODE_______________________________________________________________________________________________________________________ DISTRICT USE ONLY CUSTODIAL FEE @ $25.00/HR X _________________HOURS =________________ASSIGNED PERSONNEL__________________________________________ SECURITY FEE @ $20.00/HR X __________________HOURS =________________ ASSIGNED PERSONNEL__________________________________________ BUDGET CODE CHARGED TO (if applicable) ______________________________________________________________________________________________ CHECK NUMBER______________________ DATE of CHECK__________________ COPY OF CERTIFICATE OF INSURANCE_________________________ PERMIT APPROVED BY: ______________________________________________ ___ DATE: ________________________________________________________ PERMIT CONFIRMATION#__________________________ Once signed by applicant and approved by the District, this application becomes the applicants Official Permit for facility use for stated purpose, dates and times indicated. Applicant understands that all permits are subject to cancellation in the event that a priority activity is scheduled. Additional conditions and regulations are on reverse of this form. PERMIT IS NOT IN EFFECT ON LEGAL HOLIDAYS OR SCHOOL VACATIONS. SITE ORIGINAL (White) FACILITY SPECIALIST (Green) CIVIC CENTER PERMIT OFFICE (Yellow) APPLICANT (Pink) SECURITY (Gold) 4/8/08; Rev. A PSS-F003 Page 1 of 2 Community Meeting Room Usage Conditions(PSS-F003) To reserve a Community Meeting room(s) in the Serna Center, you must provide a description of the activity, number of attendees, and plans for your event. This is not intended as a critique of your event, but we need to review your plans for safety and procedural issues. Please read the following regulations for room usage, then sign and date that you understand and agree to these regulations. Priority of Use and Cancellation Policy Requests for use shall be given preference in the following order: First Consideration-Serna Center Employees; Second Consideration-- School Sites; Third Consideration- City of 鶹Ƶ (Joint Use Agreement); Fourth Consideration-Community. Permits will be issued in accordance with the priority needs of the district. All permits are subject to cancellation in the event that a priority activity is scheduled. Custodian A custodian must be present for all after-hours events (after 6:00 pm, Mondays to Fridays and Saturdays). A custodian will provide the Permit holder with an orientation of the room and building procedures. Custodian and utilities services cost is $25.00 per hour. CANCELLATION OF A PERMIT WITHIN 24 HOURS OF THE EVENT IS SUBJECT TO A MINIMUM OF A 2 HOUR FEE. Security Security must be provided for all after-hours events (after 6:00 pm, Mondays to Fridays and Saturdays). The school district will provide security personnel at $20.00 per hour, per 100 attendees with a two-hour minimum. CANCELLATION OF A PERMIT WITHIN 24 HOURS OF THE EVENT IS SUBJECT TO A MINIMUM OF A 2 HOUR FEE. Orientation & Check-in The person in charge of your event must contact the custodian upon arrival by calling 643-9066. The custodian will provide an overview of the rooms features, restroom location, method of contacting custodian/security, and other procedures associated with the reservation. Rest Rooms The only restrooms available for after-hours events are located on the first floor in the main hallway. Moveable Walls Make no attempt to move or adjust the partition walls within the community rooms. Contact a custodian if any adjustment is needed. These walls need special tools to move and they should not be touched with bare hands (oil from hands leaves stains). Do not attach anything to these walls, i.e., pins, tape, nails, etc. Signs, Plaques, Taping, Writing on Walls Do not attach anything to the fixed walls except by means of blue painters tape. If flip chart paper is attached to a fixed wall with blue tape, do not write on the paper with felt pens. The ink will bleed through the paper onto the wall. Use an easel for this purpose. Emergency Exits These exits are for emergency use only. They are armed with an audible alarm and connected to the fire and police departments. Audio Visual Equipment The Serna Center Community Meeting Room has wall mounted audiovisual connections within each room segment. The Permit holder can provide their own equipment or make special arrangements with the District to rent equipment. Alcohol No alcoholic beverages are allowed on the premises. Mechanical Window Shades Several of the Community Meeting Room have electrical/mechanical window shades. Do not touch the shades. Pressure on the shade material will cause them to leave their tracks. Contact the custodian if any adjustment is necessary. Chairs, Tables, and Closets Each Community Meeting Room has closets that store tables and chairs. Do not access tables and chairs in these closets. Contact the custodian if more chairs or tables are needed. Do not move tables, the custodian will make any necessary adjustments. I, __ ______________________________________ have read and agree to the above regulations regarding the use of the Serna Center Community Center. (Print name) ____________________________________________________________________________________________________________________________________________________ (Signature) ( Date) 4/8/08; Rev. 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