Facilities Use Request Form
ROXBURY TOWNSHIP BOARD OF EDUCATION
Application for the Use of School Facilities Please return completed application to the school in which the usage is requested at least 30 days prior to the date of the event. Please note, out of district profit making organizations are not eligible for the use of facilities.
Facility Requested (School):
Roxbury High School
Eisenhower Middle School
Lincoln-Roosevelt Elementary School
Franklin Elementary School
Jefferson Elementary School
Kennedy Elementary School
Nixon Elementary School
Rooms Requested (Gym, Cafeteria, Auditorium, Library, Classroom, Athletic Field):
Time Requested (start/end): Please include set up time in request.
Name of Organization:
Please select one:
Please select one:
For Profit Organization
Non Profit Organization
Set Up Requirements. Please check all that apply:
Public Address System (microphones)
Event Set Up/Breakdown (additional tables/chairs requested. Please include set up diagram for specific room arrangement. This will be kept on file in Aramark office for this event.
Auditorium/Athletic Sound System & Lighting (*fees may apply)
Additional services requested:
Number of persons attending (Groups of over 200 people may be required to hire security guards for this event):
Please note a Hold Harmless Agreement & Insurance Certificate listing the Roxbury Board of Education as additional insured are required by all applicants requesting use of school facilities. Profit making organizations must secure special use permits from the local fire official. Applications are available in the Assistant Superintendent Business Office.
Smoking is not permitted in school facilities. Animals are not permitted in school facilities.
Contact person shall be responsible for enforcing the Board of Education regulations and for the payment of all charges. A complete listing of Board of Education regulations (regulation number 7510) and policies may be found on the website: http://www.roxbury.org/domain/46.
Just an example.