BCPS FACILITY REQUEST FORM:
Western High and Middle School Complex
Today's Date :
Contact Information
Contact Person :
Name of the person requesting use.
BCPS Employee? :
Yes
No
If NO, Organization:
Contact Phone :
*
Contact Email :
*
Facility Reservation
Room or Space :
Ex: Auditorium, gym, classroom #, etc.
Total Persons :
Maximum amount of people you expect to attend.
Activity or Use :
Admission Charged? :
Yes
No
Reservation Date :
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2009
2010
to
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2008
2009
2010
Start Time :
AM
PM
(Please be clear about times) Ex: 7:15 PM
End Time :
AM
PM
Equipment Request
Enter numbers required or yes/no.
Chairs :
Tables :
P.A. System :
Yes
No
Trash Bins :
Podium :
Yes
No
Other :
Computer &
Video Projector :
Yes
No
Facility Assistance
Custodian :
Yes
No
HVAC :
Yes
No
Automated after normal school business schedule.
Lighting :
Yes
No
Automated after normal school business schedule.
Tech Crew :
Yes
No
Required for
Auditorium
programs.
Other :
Additional Comments and/or Requests