Sackets Harbor Central School District Request for Building Use Please note: School functions will take precedence over all activities by non-school groups.

Your Name_______________________________ Date______________________ Class, Group or Organization involved__ Activity and Purpose

Chaperones (list by name)

Room (s) requested Special Set Up/Equipment Needed (Be specific with amounts, number of items etc.) _____

Date____________________ Activity Time: From ____________ To ________ Time at which Room(s) will be needed_____________________________________ Substitute Required? _______ Yes ________ No

Time ___________________

Student special needs have been addressed ________ Yes ________ No

APPROVAL Please note: Form is to go to building principal first. Building Principal __________________________

Date

Superintendent _____________________________

Date

Copies to: Person making request, Building Principal, Cafeteria, Maintenance, Technology, Substitute Caller Outside Person/Organization must meet with Ms. Gaffney, Mrs. Tibbles or Mr. Kellar prior to the event for clarification purposes. 11/17

Building Request Use Form - updated 2017.pdf

Class, Group or Organization involved__ ... Please note: Form is to go to building principal first. ... Displaying Building Request Use Form - updated 2017.pdf.

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