RESERVATION FOR THE USE OF FACILITIES

Requesting Party: _________________________________________ Date Requested: ___________

Organizer’s/ Delegate’s Printed Name & Signature

Purpose(s): _______________________________________________________________

Actual Use: ____________________________ _______________________

Date(s) Time

Request to use: Please check

_____ Covered Courts _____ Speech Laboratory

_____ AVR’s 1,2,3 & 4 _____ Testing Room
_____ Computer Lab.’s 1, 2,3 _____ Classroom/s

_____ Others (Specify) ____________________________

Materials/Equipment needed: Please check

____ Sound System ____ Microphone/s(how many) ____

____ Chairs (how many) ____ ____ Tables (how many) ____
____ Electric Fan/s ____ Others (Specify) ______________________________

Assessment of Rent charges: __________________ OR#/Amount/Date ________________________

(AP Admin)

Endorsed by: Approved by:

Mitos E. Ycong Rogelio L. Gawahan, PhD

Asst. Principal for Administration Principal

To the Guard: Take note of Time In ____________ Time out _____________

 Xavier University Senior High School
Ateneo de Cagayan

Term and Conditions on the Use of XUSHS Facilities

1. Rent charges must be paid in full a day before the use of the facility/ies.
2. The following must be observed strictly:
a. No ID, No Entry Policy
b. University Dress Code Policy
c. No Smoking Policy
d. No Drinking of Alcoholic Beverages
e. School Traffic Rules
f. Single-use plastic bottles and polystyrene-based (styrofoam) materials are NOT allowed in the
entire campus. You may bring your own reusable water bottles.
3. When the activity goes beyond the regular or stipulated time, the organizers will pay the hourly rate or the
fraction thereof.
4. Participants of the activity should not go beyond the premises being rented.
5. The organizers and the participants of the activity are expected to take care of the facilities of XUSHS.
Organizers shall be held liable for any damage caused to the rented facility.
6. Xavier University Senio High School shall not be held liable for any accident or injury of any nature
that may occur involving the participants.
7. Xavier University Senior High School should not be held liable for any loss of property of the
participants.
8. Xavier University Senior High School reserves the right to discontinue an activity that violates the
policy of the school.
9. Xavier University Senior High School reserves the right to refuse an organization who fails to comply
with the terms and conditions stated herein.
10. The Organizer is responsible for securing all necessary government permits for the event, shall
make the arrangements for any required presence of such agencies as the Red Cross, PNP, Bureau
of Fire and/or Bomb Squad personnel, before, during and after the event, and the provision of
medical personnel and an emergency vehicle at the venue. Inform the AP Administration office if
these are present.
11. The Organizer shall enforce upon their participants the Inter-Agency Task Force (IATF) COVID-19
guidelines on wearing face mask, hand washing or use of alcohol or hand sanitizer, and maintain
social distancing.
12. The Organizer shall waive Xavier University Senior High School’s liability for any accident or injury,
of any nature, which may occur involving the participants and its organizer/ during the conduct of
the event.

Conforme: Date:

_______________________________________ ________
Organizer’s/Delegate’s Printed Name & Signature