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CHRHS Request for Facility Use
Please complete and return to: jane_self@fivetowns.net
Click here for fillable form
Organization: __________________________________________Today’s Date: ______________
Contact Name: ____________________________Phone: ____________ Email: ______________
Address: ________________________________
________________________________
Name of Event: _________________________________________________________________
Type of Event: music dance speaker meeting other __________________
Fee Category: are you charging an entrance fee to your event? Yes No
Date of Event: _____________ Need Snow Date? Yes No
Time of Event:_____________ Set-up Time: ______________ End Time: ___________
Rooms Requested: Strom Gym
Black Box Mini Gym
Dressing Rooms Varsity Fields
Chorus Room Practice Fields
Band Room Track
Café Parking Lots
Café Concessions Outdoor Concessions Classrooms: need ______ classrooms Other: ______________
Equipment: Piano Baby Grand Piano Upright Projector
Tables: ______ Chairs: ____ Other: ______
Strom Tech Needs: Sound: vocal mics instrumental mics
Lights: general stage/house lighting specials
Stage Management Load in/out assistance
Additional Information:
Office Use Only:
Notify: __________Keith ____________Rick ____________Susan
Calendared: Deposit Rec’d: Insurance Rec’d:
Contract Sent: Event Billed:
Contract Rec’d: Invoice Paid:
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