Birmingham Community Education 2436 W. Lincoln, Suite F102

Birmingham, MI 48009 (248) 203-3800 (248) 203-3818 Fax

www.communityed.net

BIRMINGHAM PUBLIC SCHOOLS COMMUNITY EDUCATION DEPARTMENT 2019-2020 Adult Community Sports Gym Application for Weekday Programs

$55 per hour for a MIDDLE SCHOOL GYM (Berkshire, BCS, Derby, West Maple) FULL gym only - no half rentals will be allowed.

$45 per hour for an ELEMENTARY GYM (Beverly, Bingham Farms, Greenfield, Harlan, Pembroke, Pierce,Quarton) Return this application with $25 nonrefundable processing fee.

The contact person below will be responsible for full payment and will be the Community Education contact

Contact Person:_________________________________________ E-mail address:_______________________________________________

Home Phone________________________ Cell Phone ______________________________ Work Phone ___________________________

Street Address_____________________________________ City______________________________ Zip___________________________

Session I September 16-December 13, 2019 Session II January 2-March 31, 2020 Session III April 1-May 22, 20209

Gym _____________________________

Day _____________________________

Start/End Time___ ____________________

Start/End date________________________

Gym _____________________________

Day _____________________________

Start/End Time___ ____________________

Start/End date________________________

Gym ______________________________

Day _____________________________

Start/End Time______________________

Start/End date______________________

Please read the following disclaimers and sign below indicating you agree to these terms.

You may choose, before you make payment, on the number of weeks in a session you wish to play. Please note: School and District events take precedence over all Community Education rentals. Once the number of weeks has been determined, you must pay in full for the session, prior

to receiving your “Facility Permit.” REMINDER: CARRY THIS PERMIT WITH YOU.

There will be no refunds or make-ups for rental times not used. Community Education will give you one free week if inclement weather or a

school event causes a cancellation of your rental time. Your refund amount will be applied to the next session as a discount.

Please note you will need to send any change to your permit IN WRITING at least 48 hours in advance, otherwise you will be charged for the reserved time. If you will not be using the gym on a specific day, or wish to cancel your gym use entirely, please fax or email the information

immediately to Meli Zikakis at: Community Education, 2436 West Lincoln, Birmingham, MI 48009. Fax Number: 248-203-3818. Email: MZikakis@birmingham.k12.mi.us

THE INDIVIDUAL WHO SIGNS BELOW MUST BE PRESENT DURING THE GYM TIME AND HAVE THE FACILITY USE PERMIT WITH THEM.

I (we) have read the policies governing the use of school buildings and agree to meet the requirements of them. In addition, I (we) agree to indemnify and hold harmless the school districts and its agents and employees from and against all claims, damages, organization’s use of the school facility including bodily injury, sickness, disease, or death injury to or destruction of tangible property including the loss of use resulting therefrom and including loss or theft or damage to any of the school district’s fixtures, equipment and personal property which are part of or located on the premises and including such property owned by students or employees of Birmingham Public Schools. I (we) understand that no guns, weapons, or guard dogs are allowed in any school building or on any school district property without prior written permission. (Government law enforcement officers are exempt; private security guards are not exempt.)

________________________________________________________________________ _______________________________ SIGNATURE PRINT NAME DATE

NOTICE OF NONDISCRIMINATION The Board of Education is committed to maintaining a learning/working environment in which all individuals are treated with dignity and respect, free from discrimination and harassment. There will be no tolerance for

discrimination or harassment on the basis of race, color, national origin, religion, sex, sexual orientation, marital status, genetic information, disability or age. The District prohibits harassment and other forms of discrimination whether occurring at school, on

District property, in a District vehicle, or at any District related activity or event. The Superintendent will designate compliance officers and develop and implement regulations for the reporting, investigation and resolution of complaints of discrimination or

harassment. The following people have been designated to handle inquiries regarding the nondiscrimination policies: Students - Inquiries related to discrimination on the basis of disability should be directed to: Executive Director of Special Education, 31301

Evergreen Road, Beverly Hills, MI 48025, 248.203.3000. Direct all other inquiries related to discrimination to: Assistant Superintendent of Human Resources, 31301 Evergreen Road, Beverly Hills, MI 48025, 248.203.3000

For Office Use ONLY FSD#: __________ CLASS ID __________ Rate: ______________# of Sessions: _______________

Dates Not Available: ____________________________________________

updated July 2019