Medina High School Facilities Request Form Please Print, Pen Only

Today’s Date____________________________________________________

This Box For School Use Only

Requested by___________________________________________________ Address________________________________________________________

Contract Needed___________________

City________________________________State_______ Zip_____________ On Calendar ______________________ Main Phone_____________________________________________________ Copies Made______________________ Email__________________________________________________________ Secondary Phone________________________________________________

Tech Assigned_____________________

Date(s) of your activity

Your Group/Business/Team/Organization

Select what facilities you are requesting from below (select all that apply) Main Stage

PAC Lobby

Cafe/Senior Commons

Choir Room

Middle Stage

Distance Learning

Cafeteria - Main

Band Rehersal Room

Studio Theatre

Media Center

Cafeteria - Middle

Orch. Rehersal Room

If not listed, other facility request(s)____________________________________________________________________ Reason for facility request Begining and ending time of your activity

Set-up start time

Equipment (select all that apply)

Tables (how many)_____________________

Podium

Chairs (how many)_____________________

Projector (if computer is needed list file type(s) in special request section)

Microphones (how many)________________

Music Stands (how many)_____________

Lavalier______

CD / DVD Player

Handheld______

Shotgun_____

If not listed, other equipment request(s)(shell, risers,etc.) ______________________________________________________

Special requests/instructions

“MUST BE TURNED IN AT LEAST ONE WEEK PRIOR TO EVENT” Circle One

FOR PAC OFFICE USE ONLY

Circle One

Security, YES / NO facility rental/staffing charges, YES / NO Administrator Approval_________________________________________________Date________________________ WHITE-Office

YELLOW-As Needed

PINK-Customer

GOLDENROD-Tech

MHS Rental Request Form fillable.pdf

This Box For School Use Only. Contract Needed___________________. On Calendar ... WHITE-Office YELLOW-As Needed PINK-Customer GOLDENROD-Tech. Please Print, Pen Only. FOR PAC OFFICE USE ONLY ... MHS Rental Request Form fillable.pdf. MHS Rental Request Form fillable.pdf. Open. Extract. Open with.

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