The undersigned applicant makes application for the use of the school building designated below.  The applicant will provide police protection at its own expense, if necessary, to maintain order and to properly protect the building.  This is required if admission is charged.

Please refer to Policy 905.1 to determine the proper use of school facilities.  The applicant is responsible for enforcing these regulations.

The undersigned, hereafter referred to as "organization," states that it shall hold the North-Linn Community School District, hereafter referred to as "district," harmless from any and all damages and claims that may arise by reason of any negligence on the part of the organization or the district, and its officers, employees or agents, in the use by the organization of any facilities owned by the district.  In case any action is brought therefore against the district or any of its officers, employees or agents, the organization shall assume full responsibility for the legal defense thereof, and upon its failure to do so on proper notice, the district reserves the right to defend such action and to charge all costs, including attorneys' fees, to the organization.

 Building:                             Purpose:                                 

Facility to be used________________________

Date: _________________ Hours: _________________

Name of organization making application: ___________________________ 

Name of responsible person making application:_______________________

Dated at________, Iowa, this_____day of _______, ______

_______________________________By_________________________    _________________

(Organization)                signature             Title

Address_____________________     Phone #________________

North-Linn Community School District

By___________________________________Title_______________________

Approved 10/20/11     Reviewed  3/15/23              Revised