Policy Homepage

KF-FRM1

Application for Community Use

KF-FRM1 

Hopkinton Public Schools 
Application for Community Use 

DIRECTIONS: Complete applications should be submitted (21) days prior to the requested use date to the Buildings & Grounds Office via email Communityuse@hopkinton.k12.ma.us , fax: 508-497-9804 or to the office by mail: 89 Hayden Rowe Street, Hopkinton, MA 01748 or in person: 88A Hayden Rowe Street. Responses to requests and Permits will be issued via email. Please call the office at 508-497-9870 with any questions. 

APPLICANT INFORMATION 

If APPLICANT INFORMATION (pages 1&2) are complete and filed for the academic year and no changes have occurred for the applying organization, proceed to EVENT INFORMATION (page 3). 

1. ________________________________               4. ________________________________________
            ORGANIZATION                                               CONTACT NAME 

2. _________________________________             5. ________________________________________
           BILLING ADDRESS                                             CONTACT PHONE 

3. _________________________________             6. ________________________________________
           CITY, STATE, ZIP                           CONTACT E-MAIL (permits will be issued electronically) 

7. PERCENTAGE OF HOPKINTON RESIDENTS CERTIFICATION 

On behalf of ________________________________, I ______________________________ certify
                               (ORGANIZATION)                (PRINT CONTACT NAME) 

The Percentage of Hopkinton residents in the ____________________ is ____%. I understand the                                                                                             (ORGANIZATION) 

percentage is used for fee determination in accordance with the fee schedule and any misrepresentation may result in loss of facility use privileges. 

Signature _______________________________ Date _________________ 

8. IS THE ORGANIZATION A NONPROFIT? ____YES (CERTIFICATE ATTACHED) ____NO

9. ARE THERE ADMISSIONS OR FEES CHARGED FOR THE EVENT/ACTIVITY? ___YES ___NO 

10. THE ORGANIZATION'S CERTIFICATE OF INSURANCE EXPIRES: __________________ (PLEASE ATTACH THE CERTIFICATE OF INSURANCE LISTING 'HOPKINTON PUBLIC SCHOOLS’ AS AN ADDITIONAL INSURED. INSURANCE MINIMUMS AS SET FORTH IN THE FACILITY USE POLICY MUST BE MET.) TOWN DEPARTMENTS EXCLUDED. 

11. FACILITY USE POLICY & STANDARD HOLD HARMLESS INDEMNITY AGREEMENT 

I__________________________________ its officers and members all, have read the Facilities Use  
   NAME OF LESSEE (ORGANIZATION)                          Policy 

and agree to the terms of use stated therein. Through the signing of this document by an authorized party or agent, indemnify, hold harmless and defend the Hopkinton Public Schools and their agents and employees from all suits and actions; including attorney's fees and all costs of litigations and judgments of every name and description brought against the Hopkinton Public Schools as a result of loss, damage or injury to person or property by reason of any act or failure to act by _____________________, its agents, servants, or employees. NAME OF LESEE                                             (Organization) 

_________________________________           ____________________ 
Signature of Authorized Agent        (Contact) Date 

_________________________________ 
Printed Name of Authorized Agent 

Community Use Application – Page 1 of 5 
Hopkinton Public Schools do not discriminate on the basis of race, color,
national original, sex, gender identity, disability, religion or sexual orientation. Revised

8.2.2019

12. M.G.L. CHAPTER 269 

In addition to signing the acknowledgment statement, it is an expectation of the Hopkinton Public Schools that user groups will distribute the following statute language to any adult who will be supervising an event in or on the district's facilities. Printable Form for Distribution 

AN ACT increasing the penalties for hazing. Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows: 

Chapter 269 of the General Laws is hereby amended by striking out sections 17 to 19, inclusive, and inserting in place thereof the following three sections: 

Section 17. Whoever is a principal organizer or participant in the crime of hazing, as defined herein, shall be punished by a fine of not more than three thousand dollars or by imprisonment in a house of correction for not more than one year, or both such fine and imprisonment. 

The term "hazing" as used in this section and in sections eighteen and nineteen, shall mean any conduct or method of initiation into any student organization, whether on public or private property, which willfully or recklessly endangers the physical or mental health of any student or another person. Such conduct shall include whipping, beating, branding, forced calisthenics, exposure to the weather, forced consumption of any food, liquor, beverage, drug or other substance, or any other brutal treatment or forced physical activity which is likely to adversely affect the physical health or safety of any such student or other person, or which subjects such student or other person to extreme mental stress, including extended deprivation of sleep or rest or extended isolation. 

Notwithstanding any other provisions of this section to the contrary, consent shall not be available as a defense to any prosecution under this action. 

Section 18. Whoever knows that another person is the victim of hazing as defined in section seventeen and is at the scene of such crime shall, to the extent that such person can do so without danger or peril to himself or others, report such crime to an appropriate law enforcement official as soon as reasonably practicable. Whoever fails to report such crime shall be punished by a fine of not more than one thousand dollars. 

Section 19. Each institution of secondary education and each public and private institution of post secondary education shall issue to every student group, student team or student organization which is part of such institution or is recognized by the institution or permitted by the institution to use its name or facilities or is known by the institution to exist as an unaffiliated student group, student team or student organization, a copy of this section and sections seventeen and eighteen; provided, however, that an institution's compliance with this section's requirements that an institution issue copies of this section and sections seventeen and eighteen to unaffiliated student groups, teams or organizations shall not constitute evidence of the institution's recognition or endorsement of said unaffiliated student groups, teams or organizations. 

Each such group, team or organization shall distribute a copy of this section and sections seventeen and eighteen to each of its members, plebes, pledges or applicants for membership. It shall be the duty of each such group, team or organization, acting through its designated officer, to deliver 

Community Use Application – Page 1 of 5 
Hopkinton Public Schools do not discriminate on the basis of race, color, national original, sex, gender identity, disability, religion or sexual orientation. 

Revised 8.2.2019

annually, to the institution an attested acknowledgement stating that such group, team or organization has received a copy of this section and said sections seventeen and eighteen, that each of its members, plebes, pledges, or applicants has received a copy of sections seventeen and eighteen, and that such group, team or organization understands and agrees to comply with the provisions of this section and sections seventeen and eighteen. 

Each institution of secondary education and each public or private institution of post secondary education shall, at least annually, before or at the start of enrollment, deliver to each person who enrolls as a full time student in such institution a copy of this section and sections seventeen and eighteen. 

Each institution of secondary education and each public or private institution of post secondary education shall file, at least annually, a report with the board of higher education and in the case of secondary institutions, the board of education, certifying that such institution has complied with its responsibility to inform student groups, teams or organizations and to notify each full time student enrolled by it of the provisions of this section and sections seventeen and eighteen and also certifying that said organizers and participants of hazing, and that such policy has been set forth with appropriate emphasis in the student handbook or similar means of communicating the institution's policies to its students. The board of higher education and, in the case of secondary institutions, the board of education shall promulgate regulations governing the content and frequency of such reports, and shall forthwith report to the attorney general any such institution which fails to make such report. 

ACKNOWLEDGMENT 

On behalf of ____________________________ (Organization) I ___________________ (Contact) certify I have received a copy of M.G.L. Chapter 269; Sections 17-19, An Act Prohibiting the Practice of Hazing, and have distributed a copy of the law to its members, plebes, pledges and applicants for membership; and that the _____________________________(Organization) understands and agrees to comply with the law. 

Signed: _____________________________ Date: ____________________________ 

Community Use Application – Page 1 of 5 
Hopkinton Public Schools do not discriminate on the basis of race, color, national original, sex, gender identity, disability, religion or sexual orientation. 

Revised 8.2.2019

EVENT INFORMATION 

12. EVENT TITLE/DESCRIPTION: ______________________________________ 

13. REQUESTED USE DATE(S): ______________________________________ 

(MO/DAY/YR) 

__ MONDAY ____________________     ____FRIDAY _______________________

__ TUESDAY _____________________    ____SATURDAY _______________________

__WEDNESDAY__________________    ____SUNDAY _______________________

__THURSDAY ____________________ If more dates/space is needed complete attached sheet 

TIME: BEGINNING: _____________a.m. / p.m. ENDING:________________ a.m. / p.m. INCLUDE SET UP AND BREAKDOWN TIME 

14. USE OF FACILITY REQUESTED: 

Location: __High School ____Middle School ____Hopkins Elementary 

__Elmwood Elementary ___ Marathon Elementary 

Area: ___ Auditorium ____ Cafeteria ____ Gym ________________ ___ Kitchen ____    Library ____ Parking Lot ___________ 

___ Classroom (High School & Middle School only) 

___ Other (please describe): __________________________________ 

___ Field # (be specific):________________________ Buildings and Grounds/Campus Map 

Alternate location / area / field in the event the first choice is not available:_______________________ 15. APPROXIMATELY HOW MANY WILL BE ATTENDING?_____# Adults ____# Children

16. WHO WILL BE THE ADULT RESPONSIBLE DURING THE EVENT? ___________ 

17. ____ CHECK TO INDICATE EMERGENCY PLANS HAVE BEEN ESTABLISHED WHICH INCLUDE EMERGENCY EVACUATION AND RELOCATION. This is required for all user groups. 

18. WILL FOOD/BEVERAGES BE SERVED: ____YES ____ NO 

19. WILL FOOD/BEVERAGES BE SOLD: ___ YES ____NO 

20. WILL EQUIPMENT OR DECORATIONS BE BROUGHT ON OR INTO THE FACILITY? _____ YES (describe below) _____ NO 

Community Use Application – Page 1 of 5 
Hopkinton Public Schools do not discriminate on the basis of race, color, national original, sex, gender identity, disability, religion or sexual orientation. 

Revised 8.2.2019

21. EQUIPMENT USE REQUESTED: (availability is limited) 

___ Public Address System ____ Chairs #___ ___ Piano 

___ Podium ____ Tables #___ ____ Spotlight ___ Light/Sound Equipment _____ Miscellaneous (please describe)______________________ 

22. FEES I have reviewed the Rental Fee Schedule in the Community Use Handbook and understand that additional fees may be assessed if custodial or maintenance staff are required to take time away from their regular duties to help with this event ___Yes ___ 

23. FACILITY USE REQUEST SUBMITTED BY: 

______________________________ ____________________________ 
            (print name)                 (organization) 

______________________________ ____________________________ 
          (email address)                   (phone) 

Please note: Some events may require a meeting with the Director of Buildings & Grounds 

Community Use Application – Page 1 of 5 
Hopkinton Public Schools do not discriminate on the basis of race, color, national original, sex, gender identity, disability, religion or sexual orientation. 

Revised 8.2.2019