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(Please prepare application in quadruplicate. Route all copies to Community Schools Di) <br /> Distribute copies as follows: 1 copy to applicant, 1 copy to Principal , 1 copy to Busy <br /> Office, and 1 copy to file in Superintendent's Office.) <br /> ' CHAPEL HILL-CARRBORO CITY SCHOOLS <br /> APPLICATION FOR USE OF SCHOOL PLANT AND/OR GROUNDS <br /> (To be prepared in original and. 3 copies) <br /> REQUEST FOR USE OF' +Gci 4/L h- 14 44 �} ' <br /> AME OF PLAINT �� L PART OF PLANT <br /> l <br /> REQUESTED BY ./ ,/ di A 4 r'AI .— AK 1. S 'Jo E�' • <br /> MAILING ADDRESS ; Mpg T TELEPHONE <br /> DATES . <br /> DESIRED' MONTH, DAY 3 YEAR On HOURS 4,�3C2 /4� <br /> 1,t�Y� /24k, lURPOSE FOR WHICH REQUEST IS MADE / 1910r gird <br /> TYPE OF PROGRAM TO BE GIVEN &;. L�p,� ; U,•ey�e ef, it <br /> AO d <br /> I certify that I am authorized to act for the above-named organization and that <br /> organization will be responsible for any and all damages done to the plant or eq <br /> ment while being used by said organization, and that the charges as stated will <br /> paid. I further certify that all funds raised above expenses go to the above-nai <br /> requesting organization. It is also agreed and understood that no refreshments <br /> be served except in cafeterias. <br /> IN ADDITION, I agree to fill out the Use Report Form. provided by the Community <br /> Schools Office (used to record data related to the after-school use of school fal <br /> ties) and return it within the week following the last day of use as requested al <br /> If a religious organization, the Minister, SIGN D TES'' <br /> Priest, or Rabbi , must also sign. <br /> TITLE OF OFFICE e -4/64-e. <br /> APPROVAL OF PRINCIPAL <br /> The above dates do not conflict with any schedule or planned school program. <br /> PRINCII <br /> PRINCIPAL'S RECOMMENDATION: <br /> I approve the above application, subject to dates being approved by the principal <br /> See Schedule of Fees for cost. SUPERINTENDE <br /> APPLICATIONS AVAILABLE AT ANY SCHOOL PRINCIPAL'S OFFICE OR FROM SUPERINTENDENT'S nFFtrr <br />