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Blank Facility Request Form 15-16 Fillable
Blank Facility Request Form 15-16 Fillable
PleasecontactLSHSActivitiesOfficewithanyquestionsorforCokeproductinformation
at8169862107.LSHSisat:400SEBlueParkway,Lee'sSummit,Mo64063
GROUPCATEGORY:
LSHSGroup_____
R7DistrictGroup_____
OutsideofDistrictGroup_____
NameofEvent_____________________________________________________________________________________
SingleDayEvent
MultipleDayEvent
Date:____/____/____
Repeats?______(ExplaininNotes)
Dates:____/____/____to____/____/____
Phone#________________Alternate#__________________
(PleasehaveonecontactpersonfromtheorganizationworkwiththeLSHSstaff.Thankyou!)
Location(s)/Area(s)__________________________________
Actualtimeofevent:Start________
Willfoodorsnacksbeserved?_______________
End________
Numberofpeopleattending_______
Setupneedstobecompletedby_____________(timepartyneedsaccesstoarea)
Notes:________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
FACILITYSETUP(Ifyouneedaspecificsetuppleasedetailinnotesorattachadiagram/explanation)
Table(s)#_____
Chair(s)#_____
EquipmentSetup
Sound&LightSystem
Podium
Microphone
PortableProjectorandScreen
ProjectorandScreeninLectureHall
ProjectorandScreeninPAC
CustodialAssistanceNeeded(pleaseexplain)
CafeteriaKitchenEquipment(SpecialPermission
YesorNo
Arrangement(attachdiagramordetailinnotes)
Explanation(Ifnecessary)
Required,FeesInvolved,ArrangethroughActivitiesOffice)
DRINKS(OnlyCokeproductsaretobeusedinR7SchoolDistrictbuildings)
Soda(#cans)_____
Coffee(#ofcups)_____
Bottledwater(#16.9oz)_____
($.36percan)
($.38perbottle)
Cafeteriawillbill@50100cups
Anigloocooler(s)oficewateravailableonrequest.Youwillneedtoprovideyourowncups.____________
Accountsdrinkstobechargedtoorpartytobill(ifapplicable):_______________________________________
AdministrativeApproval:Dr.Faulkenberry_____ChadHertzog_____DateSubmitted:____/____/____
PleasereturnformtoReneeBaxterintheLSHSActivitiesOffice.
EmailReneeatrenee.baxter@lsr7.netorfaxformto9862095.