Equipment Needs o Sound System (2 mics, computer input, board, speakers) o Projector o Projection Screen o TV / DVD o Campfire o Stage o Recreation Equipment: o Dodgeball o Basketball: Outdoor / Indoor o Volleyball: Sand / Indoor o 9-Square-In-The-Air o Soccer o Frisbee Golf o Other: Total Fee: $ Date Received: Deposit: $ Date Received: Fee Remaining: $ Date Received: Signed Date Group Activity Participation Agreement Activity Information Name of sponsoring organization: Address: Phone: Name of coordinator: Date of Activity: Description of Activity: I acknowledge that participation in the activity described above involves risk to the participant and may result in various types of injury including, but not limited to, the following: sickness, bodily injury, death, emotional injury, personal injury, property damage, and financial damage. In consideration for the opportunity to participate in the activity described above, our group acknowledges and accepts the risks of injury associated with participation in the activity. We accept personal financial responsibility for any injury or other loss sustained during the activity or while at/on Oil Belt Christian Service Camp’s facilities and property. By signing below I am giving consent for to attend the activity described above. I will in no way hold Oil Belt Christian Service Camp, it’s board, staff or management responsible for any accident that might befall the participants. I authorize Oil Belt Christian Service Camp to use any pictures, videos, or slide as may be needed for its records or public relations program. Signature of Coordinator: Date: Check-In & Check-Out Procedures Before your group arrives, we will contact you about scheduling set-up / tear down for your event. Generally, a staff member will meet you 30 minutes before your event start time and expect to have everything cleaned up 30 minutes afterwards. We let groups set up their own needs, but we will be there to help and gather equipment. For clean-up, when your event is over, please strive to return the facility back to how you found it. For example: • Put away tables, chairs, equipment, etc back where you found them • Sweep and spot mop spills, mud, etc. • Take trash to dumpster (located on west side of activity building) • Let a staff member know if something was broken or not functioning
Equipment Needs. ❑ Basic Microphone ❑ PowerPoint ❑ Ticket Booth ❑ Podium ❑ Scorers Table ❑ Specialized Sound ❑ Video ❑ Dressing Room ❑ Set Prep Area ❑ Bleachers ❑ Basic Lighting ❑ Stage ❑ Choir Room ❑ Technician ❑ Tables/Chairs ❑ Specialized Lighting ❑ Seating ❑ Band Room Other specialized needs/equipment: Setup Required? ❑ Yes ❑ No Who will be responsible for setup? ❑ Group ❑ District Setup fees: $ _ Is take-down required? Who will be responsible for take-down? Take-down fee: ❑ Yes ❑ No ❑ Group ❑ District $ _ Is clean-up required? Who will be responsible for clean-up? Clean-up fees: ❑ Yes ❑ No ❑ Group ❑ District $ APPLICATION FOR USE OF SCHOOL KITCHEN ❑ High School ❑ Middle School ❑ Xxxx Xxxxxxxxx Elementary School (at least ten days in advance) ALL BERLIN SCHOOL KITCHENS ARE INSPECTED AND REQUIRE A “SCHOOL EMPLOYED” CERTIFIED FOOD SAFETY MANAGER TO BE ON DUTY DURING ANY EVENT USING A SCHOOL KITCHEN. The charge for a certified food safety manager is $30 per hour and must include set up and clean up time. A bill for the total cost will be submitted to the organization as soon as possible following the event. Person Responsible Date Requested _ Organization Usage Date Beginning Time to Ending Time Purpose _ Signature of Person Responsible _ +++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ TO BE COMPLETED AND RETURNED TO ORGANIZATION UPON RECEIVING REQUEST. COPIES TO HEAD COOK AND BUSINESS OFFICE. Usage Approval _ Yes _No _ Head Xxxx’x Signature _ Yes _No Principal’s Signature Date APPLICATION FOR USE OF HIGH SCHOOL THEATER This application must be submitted to the principal’s office at least ten days in advance of the scheduled event. Within one week of submitting, you will receive a copy which will indicate whether or not your request has been approved. There is a flat Theater rental/usage fee of $125.00/event plus any technician and/or custodial charges assessed. These will be invoiced post event and are payable to the Berlin Area School District. Please check below the areas needed, since only the area you check will be made available. Under no circumstances will children be permitted in the building without adult supervision. The applicant whose signature is listed below is responsible for the theater area.
Equipment Needs. Please check all that apply: Campus Event Non-Profit Non-Campus Event For Profit
Equipment Needs a. Computer, projector, speakers, screen (for PowerPoint presentation)
Equipment Needs. Ticket Booth Podium Scorers Table Specialized Sound Basic Lighting Video Stage Dressing Room Choir Room Set Prep Area Bleachers Tables/Chairs Specialized Lighting Seating Band Room Keys Setup/Takedown Other specialized needs/equip Please note any setup required Save Please save and e-mail the form as an attachment to LCHS Scheduling - xxxxxxxxx@xxxxxxxxxxx.x00.xx.xx. Include a copy of your Insurance paperwork and non-profit status. OFFICE USE ONLY 501C3 form on file Insurance paperwork on file Building Principal Approved Disapproved Facility Fees Fees Waived Total Fees Due Buildings and Grounds Approved Disapproved E-mail completed form to xxxxxxxxx@xxxxxxxxxxx.x00.xx.xx.
Equipment Needs. Speakers are encouraged to bring computers pre-loaded with the software they will need for presentations. We will provide a projector and laptop (if needed). Rooms will be set according to venue. Describe speaker’s presentation; be specific: (PowerPoint. slideshow, Q&A, etc.). Powerpoint slides Special needs for which Speaker will require assistance or accommodations: HANDOUTS: CAND Handout Policy Speaker will provide ELECTRONIC handouts 1 week prior to the event. Speaker will provide HARDCOPY handouts, if desired. Speaker will produce own copies. Please contact CAND for audience estimate. Speaker will ensure that all handouts provided electronically or as a hardcopy do not contain copyrighted material. SPEAKER Please complete ALL information below: Speaker's Signature___________________________ Date _______________________ Speaker's Name (please print) Xxxxx Xxxxxxxxxxxx Speaker's Phone Number 000-000-0000 Speaker’s E-mail Address xxxxxxxx@xxx.xxx Speaker's Address 000 xxxxxxx xxxx xx, Libertyville il 60048 ________________________________________________________________________
