Facility Use Request Form from Moss Point School District

Facility Use Request Form

Organization: Moss Point School District

Assigned To: Public User

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MPSD Use of Property Policy

The Moss Point Schools Board of Education believes that the first priority in the use of its school property is the education of children in the district. However, this district will allow the public use of indoor or outdoor school property during the nonschool hours for purposes of recreation or sport, to support active living, reduce obesity, reduce health care costs associated with obesity, increase community safety, maximize community resources, and promote community support for schools.
Local citizens are also encouraged to use the property for other reasonable general public use including religious, political, literary, community, cultural, scientific, mechanical, agricultural, or parental involvement purposes.
The board shall exercise its authority to fix and collect rentals, rates, and charges for the occupancy or use of school property in such amounts and in such manner as may be determined.
The superintendent is directed to establish rules and regulations in support of this policy. The rules and regulations will require evidence of appropriate liability insurance coverage. The school district will not permit the use of school property or equipment by any person or organization that does not furnish evidence of insurance coverage.
If the district has provided classroom space or other school facilities for a federally sponsored Head Start program and is planning to make a material change in the arrangement, the superintendent will give notice to the director of the the Head Start program at least seven (7) days prior to a school board hearing on the matter.
School districts and school district employees may not be held liable for any claim resulting from a loss or injury arising from the use of indoor or outdoor school property or facilities made available for public recreation or sport.
LEGAL REF: 20 USC' 7905, HB 540 2012
CROSS REF: Policy EBH C School Facility Rental

Your email address:

Date:

Name of person making application:

Complete address:

Telephone:

Name of organization:

Organization complete address:

Organization telephone:

Organization fax:

Name of head of organization:

Head of organization complete address:

Head of organization telephone:

Head of organization fax:

School facility wanted:

State your reasons for wanting to use the facility:

Name of person to be in charge:

Telephone:

Will admission be charged?

YesNo

Will funds be solicited?

YesNo

Will merchandise be sold?

YesNo

Use date(s):

Length of use (hours):

Opening time:

Closing time:

Estimated number of participating adults:

Estimated number of participating children:

ITEMIZED CHARGES

HOURS	ITEM	TOTAL
	x Base Rate:
	x Heat or Air Rate:
	x Heat Up or Cool Down Rate:
	x Professional Employee Rate:
	x FLSA Employee Rate:
	x Standby FLSA Employee Rate:
	x Other Charges:

TOTAL CHARGE:

Certificate of Insurance attachment:

I certify that the information given above is true to the best of my knowledge. I understand that this agreement shall become null and void should this agreement be assigned.

Yes

Applicant Electronic Signature:

By typing in your name (your “eSignature”), you accept and consent to be legally bound by this document’s statements, terms and conditions as if this document was signed by you in writing with pen on paper. You agree that no third party or other means of verification is necessary to validate your eSignature and that the lack of such third party or other means of verification will not in any way affect the enforceability of this document.

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History

Step: Someone fills out the form
Sent To: Public User, On: 5/21/2026 10:06:25 AM Central Standard Time

Moss Point School District - Facility Use Request Form