22-168.00 East Valley School District: Sullivan-SR 290 Interchange Facilities Use D 1j 6
EAST VALLEY SCHOOL DISTRICT GROUNDS USE AGREEMENT
FOR SPORTS GROUNDS/FACILITIES,YOU MUST ALSO COMPLETE CONCUSSION FORM BEFORE ANY EVSD
SPORTS GROUNDS/FACILITIES ARE APPROVED FOR USE
Dates: 10/27/22 through 10/27/22 Time:5:00-7:00 PM
Grounds/Facility Requested: East Valley Middle School-gym
The School Board of Directors wishes to encourage use of school facilities by the community as long as use is for a
lawful purpose and does not interfere with the conduct of the district's educational programs,the primary
purposes of which the buildings and grounds are intended. This includes maintenance operations and repairs
that may be required. We are pleased to offer you the use of EVSD grounds/facilities. Please treat each of these
grounds/facilities you use as if it were your own. All groups scheduled to use our grounds/facilities, must keep
the following rules in mind. If you abuse them,you could lose this opportunity. The group and the person in
charge must adhere and be responsible for the following:
1. Person in charge must be present and have approved Grounds/Facilities Use Agreement on person at all
times.
2. Keep all grounds/facilities neat and orderly. Trash is to be removed from the grounds before leaving.
3. Filling trash receptacles with sod,dirt, rocks, etc.is not acceptable.
4. Children must be under adult supervision at all times.
5. Drugs,Alcohol,and Tobacco products are not permitted on school grounds.
6. Organization must have and maintain accident and liability insurance as per Board Policy 4260.
7. Emergency Access to the fields must be maintained at all times.
8. There must be prior approval before using vehicles or any heavy equipment on the grounds.
9. Any modifications or alterations to the grounds are prohibited without prior written permission.
10. Prior Approval is needed to store or dump any material or equipment on the grounds.
11. Prior Approval is needed BEFORE ordering and placement of any porta potty facilities on the grounds.
For permission required above (Items 8-11), please contact the East
Valley School District Maintenance Department-509.927.3206
Note: Violation of any of the above rules may cause your group to forfeit the use of our grounds/facilities. The
East Valley School District thanks you, in advance,for your cooperation.
On behalf of the organization I represent,I agree to hold harmless East Valley Schools from,and
will assume full responsibility for, any and all loss, costs, damages and expenses arising out of any
accident or other occurrence suffered by and person while engaged in using the school and grounds
under this agreement.
ORGANIZATION: City of Spokane Valley East Valle epr 've:
NAME:John Hohman,City Manager ) /�
ADDRESS: 10210 E.Sprague Ave.Spokane Valley,WA 99206 Fee: " Date: (03
J/
PHONE:509-720-5000 (`
EMAIL:cityhall@spokanevalley.org
East Valley School District is an Equal Opportunity Employer Updated 1/14/2020
•
Signature: 1i�—
EAST VALLEY SCHOOL DISTRICT /
Compliance Statement for HB 1824, Youth Sports-$d Injury Polices
(attach to any building/facility use r,quest form)
Enter your full name requests the use of the East Valley Schoo •istrict facilities/grounds for the following dates:
Click arrow for start date through Click arrow for end date
Enter organization,a private non-profit youth sports :roue,verifies all coaches,athletes and their
parents/guardians have complied with mandate. .olicies for the Management of Concussions and Head Injuries
as prescribed by HB 1824,section 2 and Sudd• Cardiac Arrest Awareness as prescribed by SB 5083,section 3..
Attached is proof of insurance under an . cident and liability policy issued by an insurance company authorized to
do business in Washington State covz. ng any injury or damage with at least$1,000,000 due to bodily injury or
death or one person and at least ,000,000 due to bodily injury or death to two or more persons.
SIGNED: NI t A
Representative of Priv. e, Non-Profit Youth Sports Group
DATE:
*Note: i cess to school facilities/grounds may not be granted until all requirements of this application are
comp'. e and approved by the school district and/or designee.
East Valley School District is an Equal Opportunity Employer Updated 1/14/2020