Form Page: FacilitiesUsageRequest

Permit

BCS Facilities Usage Request

Please Review the Facility Use Agreement

I Agree to the Terms and Conditions specified in the Facility Use Agreement

(FOR External Use Only by outside agencies or organizations!)

Organization Type

If your oganization is a church, you must have been in existance for at least 3 years, and provide state proof of incorporation. If you are a 501C3 organization you must provide state proof of incorporation.

The organization making use of any District facility shall secure and maintain, at its expense, during the term of the agreement, general liability insurance with a company licensed by the State of Alabama, and have an A.M. Best Rating of “A” or better. An Accord Certificate of Insurance shall be furnished with each rental and shall be presented to the District with a signed permit and payment. The certificate shall show on its face the following:

1. The Birmingham Board of Education, Birmingham City Schools, Superintendent and their officers, employees and agents named and as additional Insured.
2. Property damage in the amount of $1,000,000 per occurrence
3. Personal injury liability (to include participants in the activity) in the amount of $1,000,000 per occurrence.

All rental fees must be paid by money order or certified check to the Birmingham Board of Education at least one week (7) days in advance of the date of use of the district’s facilities and/or grounds. The money order or certified bank check should be hand-delivered or sent by registered mail (must be received prior to date of event) to Birmingham Board of Education, Department of Finance, Room 204, 2015 Park Place North, Birmingham, Alabama 35203.

I affirm my awareness that acceptance of this application is contingent on our receipt of supporting Church or 501C3 documenation at the address below, or by email to opsupport@boextra.org

I affirm and acknowledge my awareness that acceptance of this application is contengent on your receipt of my Certificate Of Insurance at the address below, or by email to opsupport@boextra.org

(FOR Internal Use Only by Birmingham City School System sponsored organizations!)

Organization Type

Facility Room/Location 2

Days Of Week

Date

Time

No.

Start

End

Days

Hrs/Day

Audio Visual

Child Nutrition

Custodial

Room

Total

Fees .. (Room/Location 2) .. only required of external entities

Another Room/Location?

Special Lites

Parking

Facility Room/Location 3

Date

Time

Days Of Week

No.

Start

End

Days

Hrs/Day

Audio Visual

Custodial

Room

Child Nutrition

Total

Fees .. (Room/Location 3) .. only required of external entities

Another Room/Location?

Special Lites

Parking

Facility Room/Location 4

Date

Time

Days Of Week

No.

Start

End

Days

Hrs/Day

Audio Visual

Custodial

Room

Child Nutrition

Total

Fees .. (Room/Location 4) .. only required of external entities

Another Room/Location?

Special Lites

Parking

Facility Room/Location 5

Date

Time

Days Of Week

No.

Start

End

Days

Hrs/Day

Audio Visual

Custodial

Total

Room

Child Nutrition

Fees .. (Room/Location 5) .. only required of external entities

Special Lites

Parking

Financial Information

Grand Total Fee