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LEE'SSUMMITHIGHSCHOOLFACILITYREQUESTFORM

PleasecontactLSHSActivitiesOfficewithanyquestionsorforCokeproductinformation
at8169862107.LSHSisat:400SEBlueParkway,Lee'sSummit,Mo64063

GROUPCATEGORY:

LSHSGroup_____

R7DistrictGroup_____

OutsideofDistrictGroup_____

NameofEvent_____________________________________________________________________________________
SingleDayEvent

MultipleDayEvent

Date:____/____/____

Repeats?______(ExplaininNotes)

Dates:____/____/____to____/____/____

LSHS Music Parents


Organization___________________________________________________________________________________
SponsorContact____________________________

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.

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