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Building Usage Request
Building Usage Request
Today's Date:
*
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Event Date:
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Organization:
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First Name:
*
Last Name:
*
Phone Number:
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Email:
*
Billing Address:
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Event Description:
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Set-Up Arrival Time:
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Event Start Time:
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Event End Time:
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Room Use:
*
Auditorium
Staff Lounge
Conference Room
Classroom
MS/ HS Commons (without food)
MS/HS Commons (with food, no kitchen access)
MS/HS Commons (with food & kitchen access)
Elementary Commons (without food)
Elementary Commons (with food, no kitchen access
Elementary Commons (with food & kitchen access)
Elementary Gym
MS/HS Gym
Gymnastics Gym
Other (Please list in Additional Information below the room you would like to use.)
Equipment Needs (ie: tables, chairs, podium, computer, projector, PA System, screen):
*
Sports Equipment (ie: balls, nets, etc.):
*
Additional Information:
*
Building Usage Procedures Policy:
*
Yes
No
I agree to the terms and conditions of Pipestone Area Schools Building Usage Procedures Policy.
Send me a copy of the completed form to this email address
*
: