Southwest Technology Center
ADULT EDUCATION CENTER
711 W. Tamarack, Altus OK, 73521
PHONE: (580) 477-2250 WEB SITE: www.swtech.edu

Request for use of facility on the date of:       
Times needed (please be specific):

Sponsoring group or organization: (Invoice will be mailed to this address)
Name:  
Address:
City:            State: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming       ZIP:

Contact Person:
Name:  
Address:  Phone:
City:            State: Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming       ZIP:
Email:   

Purpose and Description of Use:

Are you charging an admission fee for attendees:YesNo
Number anticipated attending event:(determines room(s) needed)
Equipment needed: video projector, TV, microphone, vcr/dvd etc.( fees may apply):

The following stipulations apply:
The undersigned user of school facilities hereby agrees that he/she has authority to bind the sponsoring group or organization or individual users to:
1. Observe the rules and regulations for the use of school facilities as established in adopted Board policy, a copy of which is located at www.swtech.edu
2. Assume full responsibility for loss/or damage to school district property resulting from such use.
3. Assume full responsibility for personal injury or property damage sustained by any person as a result of such use, waive all school district liability for such injury, and agree to hold the district harmless from any and all claims of whatever nature which may be brought against the district arising from the user's use of the school premises.
4. Please note that we have short-term evening classes on most evenings and the rooms are not available for overnight use therefore you may need to secure/remove your materials. If reserving a classroom for multiple days and arrangements are made in advance the rooms can be reserved overnight for an additional fee.
5. Pay the usual and customary fee for such use as requested in accordance with the fee schedule for the requested facilities, equipment, required technician, and other fees, as required, in accordance with regulations.

Those fees are identified and total:

6. Signing this statement assures the school district that the sponsoring group or organization has read and understands the Board policies on school use and will inform all individual users that use is not for a school function and will not be supervised by the district