Williamsport Area School District
201 West Third Street
Williamsport Area Scho ol District
APPLICATION AND PERMIT FO R USE OF SCHOOL PROPERTY
Name of Date of
Applicant_____________________ ________________________ Application _________________________
Purpose of
Organization______________________ _________________________________________________________
Portion of Name of
Building Desired_______________ ______________________ School_______________________________
School Equipment Probable
Desired_______________ ______________________________ Attendance____________________________
TIME DESIRED
Day of Week Dates of Use Time of Performance
From To
Building Open
to Applicant
From To
Purpose for which
premises will be used ___________ _____________________________________________________________
Amount of Admission Will offerings be taken
to be charged___________________________________ or funds solicited?_______ ______________________
What use will be made of
proceeds of perform ance? ____________________ ________________________________________________
The undersigned hereby makes application to the Williamsport Area School District, Williamsport, PA
for the above name d applicant for use of school premises and certifies that the information abov e is correct. The
undersigned further states that he has the authority to ma ke this application for the applicant and agrees for the
applicant that the applicant will observe all rules and regulations of the School Board and of the Principal of the
school in which the prem ises is to be leased are located, and will promptly reimbu rse the school district. The
applicant will exercise the utmo st care in use of the school premises and property and will make good any
damage arising from applicant’s use of said premises and property.
____________________________ __ ________________________________
Address Signature
____________________________ __ ________________________________
Phone Number Title
Do not write below this line
The above mentioned premises w ill not be required for school purposes at the time named and issuance
of this permit hereby is approved.
Date__________________ ______ __________________________________________ Princi pal
For the following reason it is recommended that the permit not be issued:
_______________________________________________________________________________ ______________________________
Date_______________________ __________________________________________ Principal
Permit Approved and Issued ________ ___________(Date) Board of Directors
Permit Denied ___________________( Date) By _____________________________
Se cretary
BUILDING OCCUPANCY CHARGE SCHEDULE
Community Based Non-Profit Organization
Fund Raising Events Non Fund Raising Events
Williamsport Area High School
Auditorium $350 plus labor $50 plus labor
Gymn asium 350 “ 50 “
Swimmi ng Pool (Sept.–May) 175 “ 50 “
(June–August) 250 “ 100 “
Stadium – day 325 “ 50 “
Stadium – night 425 “ 175 “
Classroom – typical – each 15 “
Classroom – special – each 25 “
Middle Schools
Auditorium $125 plus labor $40 plus labor
Gymn asium 125 “ 40 “
Classroom – typical – each 15 “
Classroom – special – each 25 “
Elementary Schools
Classroom – typical – each $15 plus labor
Classroom – special – each 25 “
School connected organizations and auxiliary agencies –
A. Fund raising events – will be charged the cost of necessary labor supplied in support of the
event (see below).
B. Non fund raising even ts – no charge will be made.
1. Labor assigned by the Sc hool District in support of an event will be bill ed at the appropriate
rate plus 25% thereof to cover the cost of fr inges, processing of application, etc. Labor
includes: principal’s representative, employees with special skills (l ighting, projectionist),
police, traffic control personnel, custodial and maintenance service.
2. Special equipm ent such as risers, projectors, sound system, special lighting (not including
house lights), and not including the cost to erect or operate will be billed at the rate of $50 per
unit. Use of the concert grand piano will be billed at $150 and includes th e cost of tuning for
the event. Use of electronic timer will be billed at $75 plus co st of labor (operator).
3. The concession stand will be available on re quest to school connect ed organizations and
auxiliary agencies without additional fee. All outside organizations requesting use of the
concession stand will be charged a fee of $75. When an outside organization opts not to use
the concession stand, it will be operated by the high school athletic departm ent.
4. All organizations using school facilities shall m eet the Board’s insurance requirement except
agencies of the Federal and State governmen ts and school connected organizations and
auxiliary agencies. (See next form )
5. For events which the Board determines to be in the board spectrum of public interest, it may
waive the occupancy fee.
6. When the School District become s the co-sponsor or sponsor of an event with an organization,
the division of cost will be negotiated by the parties with the insurance requirem ent waived.
WILLIAMSPORT AREA SCHOOL DISTRICT
201 West Third Street
Williamsport, PA 17701-6463
TO WHOM IT MAY CONCERN:
Prior to actual use of school facilities, the approved applicant mu st furnish proof that it has in
force a public liability insu rance policy.
Proof shall be in the form of a Certificate of Insurance
in which the Williamsport Area School District is included as an additional insured. The term
of the insurance must cover the en tire period of use as indicated by the date and times covered
in the application, including re hearsals. If use is limited to one day, the policy may be limited
to the specific date and hours of use. The following are the minimum limits:
A. Combined single limits for bot h bodily injury and property damage
in the amount of $500,000.
If the organization has in force a general liability insurance policy in limits equal to or in
excess of those described above, a Certificate of Insurance for this policy will be accepted by
the School District, provided th e existing policy is endorsed to include Williamsport Area
School District as an additional insured fo r the period of use of school facilities by the
organization.
The Certificate of Insurance MUST include the notation th at the School District
is an additional insured.
This Certificate of Insurance must cover all da tes of use including rehearsal dates as well as
performance dates AND INCLUDE LANGUAGE WHIC H SPECIFIC ALLY COVERS
ALL PARTICIPANTS AND SPECTATORS.
This Certificate must be in the Business Office of the School District ten (10) days in advance
of the first use of the building.
PLEASE GIVE ONE COPY OF THIS MEMO TO YOUR INSURANCE AGENT