Community Nights In Schools For non-profit groups whose membership is open to all without discrimination. Application for Building Use Permit for Seattle Schools It is the intent of the Seattle School District No.1 to comply with the requirements of Local, State, and Federal regulations that prohibit discrimination based on sex, race, national origin, age, sexual orientation, marital status, and/or handicapping conditions. Failure to do so could result in the loss of State and Federal funds. 1. School 1st Choice 2ndChoice Today’s Date (Schools listed below –we will check for availability and contact you. Please allow 24 – 48 hours.) 2. Your Organization, if applicable 3. Person Responsible Day Phone Eve Phone Email Fax Address City Zip 4. Subject of meeting as it will be publicized 5. Planned activity during meeting 6. Estimated Audience Size (Maximum 50) 7. Do you intend to charge any admission/fees or donation? 0No 0 Yes If so, please explain 8. Do you need handicap parking/access? 0NO 0 YES 9. Will there be food served? 0NO 0YES If so, please explain 10. Will there be amplified music or other loud activity? 0 NO 0 YES If so, explain 11. Date(s) meeting to be scheduled. Meetings cannot be scheduled on school breaks as follows: February 18 to 22, March 8 & 15, April 8 to 12, May 17 & 27 and June 19 to September. Reservations for next school year can be made in September. ROOM (You may leave blank unless you know room to specify. Gyms, kitchens, & auditoriums are NOT available) WEEKDAY Mon – Fri, School Days (example, every 1st Tues) DATE(s) (example, 9/09, 10/10 & 11/11) START TIME Include set up time END TIME Include clean up time PM PM PM PM PM PM 12. Where did you hear about Community Nights In Schools? (School, Community Center, Friend/Neighbor, Neighborhood Service Center, etc.) 13. Has your group been meeting elsewhere? 0 Yes 0 No If so where? Typing your name below acknowledges that you have read and understand all the information on all pages of this permit application and that you agree to abide by all the terms and conditions listed herein. Your typed name further acknowledges that you are authorized to sign on behalf of the Applicant/Organization and that the Applicant/Organization agrees to protect, defend, indemnify and save harmless the District and its officers and employees from any and all claims, liabilities, damages, or rights of action directly or indirectly growing out of the use of the premises covered by this permit. Please type your name here: Date Page 2 of 2 Community Nights In Schools Application for Building Use Permit for Seattle Schools PLEASE SUBMIT AN APPLICATION FEE OF $10.00 PER MEETING AFTER YOUR RESERVATION IS CONFIRMED – MAKE PAYABLE TO SEATTLE PUBLIC SCHOOLS PAYMENT AND APPLICATION OF RENTAL ARE REQUIRED AT LEAST TEN (10) DAYS PRIOR TO THE EVENT. This application serves as an indicator of interest ONLY and creates no liability for either the applicant or the Seattle School District. Approval of this application by the District does NOT confirm availability or authorization to occupy the facilities until the District signs a permit. Mail or fax the application to: Sandra Boas-Du Pree, Citywide Division Seattle Parks Department 100 Dexter Avenue North Seattle, WA 98109-5199 Fax: (206) 684-7025, Phone: (206) 615-1812, To fill out an online form or send queries email: sandra.boas-dupree@ci.seattle.wa.us GENERAL RULES AND REGULATIONS FOR COMMUNITY NIGHTS IN SCHOOLS A. Meetings must be open to the public. Organizations must agree to adhere to the Seattle Public Schools policy related to nondiscrimination to have access to facilities through the Community Nights in Schools pilot project. B. Admission must not be charged to attend the meeting/gathering, nor can there be a charge for any activity during the meeting. C. There must be an adult supervisor with any participating group. D. All activities must end at least fifteen minutes before the building is to be closed so that it can be completely vacated before being locked. E. Liquor, drugs or smoking are not permitted. F. Any games of chance are not allowed. G. Users must leave the school facilities in the same order and condition in which they found them. H. Users are restricted to those spaces and times agreed upon. I. Users are responsible for any damage, theft, loss or clean up of school district property. J. Any fees must be collected prior to use of the facility. K. Groups using space under this program will be treated the same, for rent purposes, as any other user under the District's existing procedure on Community Use of School District Facilities, E07.01. PARTICIPATING SCHOOLS Please call if the school you are interested in is not on this list Alki Elementary, 3010 59th Ave. SW Arbor Heights, 3701 SW 104th St. B.F. Day, 3921 Linden Ave. N. Bagley Elementary, 7821 Stone Ave. No. Bailey Gatzert, 1301 E. Yesler Way Ballard High School, 1418 NW 65th St. Blaine School, 2550 34th Ave. W. Broadview-Thompson, 13052 Greenwood Ave. N. Coe @ Magnolia, 2418 28th Ave. W.* Concord Elementary, 723 S. Concord St. Dearborn Park, 2820 So. Orcas St. Denny Middle School, 8402 30th Ave. SW Eckstein Middle School, 3003 NE 75th Gatewood, 4320 SW Myrtle St. Hamilton Middle School, 1610 N. 41st High Point School, 6760 34th Ave. SW Highland Park, 1012 SW Trenton John Stanford Int’l, 4057 5th Ave. NE Kimball School, 3200 23rd Ave. So. Lawton School, 4000 27th Ave. W. Leschi School, 135 32nd Ave. Lowell School, 1058 E. Mercer St. Madison Middle, 3429 45th Ave. SW McClure Middle School, 1915 1st Ave. W. Mercer Middle, 1600 So. Columbian Way Nathan Hale, 10750 30th Ave. NE Olympic View, 504 NE 95th St. Pathfinder School, 5012 SW Genesee St. Rainier Beach, 8815 Seward Park So. Rainier View, 11650 Beacon Ave. So.* Sealth High School, 2600 SW Thistle St. Thurgood Marshall, 2401 So. Irving St. TOPS at Seward, 2500 Franklin Ave. E. Van Asselt, 7201 Beacon Ave. So. View Ridge School, 7047 50th Ave. NE Washington Middle, 2101 So. Jackson Wedgwood, 2720 NE 85th St. West Woodland, 5601 4th Ave. NW Whitman, 9201 15th Ave. NW Whitworth, 5215 46th Ave. So. Wilson Pacific, 1330 No. 90th St. Wing Luke, 3701 So. Kenyon St. *Earlier closing time