Request Form - Facility Use Request

Facility Use Agreement and Terms:

EVENT TITLE

EVENT DESCRIPTION

CATEGORY

LOCATION

ROOM/FACILITY

Schedule

EVENT DATE(S)

START TIME

END TIME

Schedule 2 (For days with a time slot different from Schedule 1)

EVENT DATE(S)

START TIME

END TIME

ORGANIZATION

Check One:

All non-profit organizations must include notarized Non-Profit Charitable Organization Exemption Form

along with this application.

(Allowed file types: PDF, DOC, DOCX, TXT, JPG, JPEG, PNG)

CONTACT NAME

EMAIL

DAY PHONE

CELL PHONE

BILLING ADDRESS

PHYSICAL ADDRESS

INSURANCE INFORMATION

COMPANY

POLICY NO.

COVERAGE

COVERAGE DATES

TO

SET UP (check all that apply)

Audio/Video

Add'l Electrical

Food

Tables/Chairs

Custodial

Lights/Sound

Security

Other

NUMBER ATTENDING

APPLICANT SIGNATURE

Print name of authorized representative and/or organization officer.

I have read, understand, and agree to all provisions of the Pharr-San Juan-Alamo ISD Facility Use Agreement and Addendum thereto, if applicable. On behalf of and as an authorized representative of the above named organization (applicant/lessee) , it agrees to abide by the Agreement and any Addendum thereto; PSJA ISD Policy GKD (Legal) and GKD (Local); and all applicable laws and rules.

An email will be sent to the email provided to confirm receipt of your request. When submitting a request you are NOT guaranteed approval, you will be notified once a decision has been made. If you have any questions regarding the status or process, please email opsadmin@psjaisd.us