LIVONIA PUBLIC SCHOOLS
Facilty Use Permit Application for an Auditorium
PLEASE INCLUDE YOUR $25.00 LPS RESIDENT/$40.00 NON
RESIDENT NONREFUNDABLE APPLICATION FEE WITH THIS FORM
AND COMPLETE BOTH SIDESAll applications for school facilities will originate with responsible organizations or individuals located within the School District. At least
seven citizens who reside within the school district must be represented by the application. The use of school facilities for the
public at large should be essentially nonprofit, educational or recreational in nature.
Permit holders agree to save and hold harmless the Livonia Public Schools and agrees to assume responsibility for all liabilities arising
incident to the occupancy of named building, it being understood and agrees that the said School District assumes no obligation
respecting the use of such premises. Additionally, the signature(s) of the permit holder(s) indicates that the permit holder(s) is
knowledgeable of the Building Use Regulations and assumes ALL responsibilities pertinent to their observance, including the payment
of actual charges pertinent to the use of District facilities and all damages done to the district grounds or buildings from the use or uses
described on this permit. Service fees may apply for custodial overtime for a minimum of two hours beyond actual use and/or if special,
clean up is required.
PRIMARY PERMIT HOLDER INFORMATION:
(Responsible for Payment of Application and Building Use Charges.)
Organization Name:
Name:
Address:
City:
Day Phone: (
)
Zip: 48
Evening Phone:
Signature of Permit Holder:
EMAIL ADDRESS:
1. NAME ____________________________________
6. NAME ____________________________________
ADDRESS ___________________________________
ADDRESS ___________________________________
PHONE:
PHONE:
_________________________________
2. NAME ____________________________________
_________________________________
7. NAME ____________________________________
ADDRESS ___________________________________
ADDRESS ___________________________________
PHONE:
PHONE:
_________________________________
_________________________________
3. NAME ____________________________________
Make checks payable to LIVONIA PUBLIC SCHOOLS
ADDRESS ___________________________________
PHONE:
_________________________________
4. NAME ____________________________________
Proof of insurance will be required before permit will
be released. Note, there are building use fees! They
will be estimated on your approved permit. Ask for
hourly fees!
ADDRESS ___________________________________
PHONE:
_________________________________
5. NAME ____________________________________
ADDRESS ___________________________________
PHONE:
1
_________________________________
INCOMPLETE APPLICATIONS WILL BE RETURNED
LPS schools activities and PTA’s are
exempt from the $25/$40 application fee
and building use fees.
Today’s Date:
Permit #:
Please allow two weeks for processing.
LIVONIA PUBLIC SCHOOLS
Department of Community Services
F
Facility Use Permit Application for an Auditorium
PLEASE INCLUDE YOUR *$25.00/$40.00 NONREFUNDABLE APPLICATION FEE WITH THIS FORM AND COMPLETE BOTH SIDES
INCOMPLETE APPLICATIONS WILL BE RETURNED
Make checks payable to LIVONIA PUBLIC SCHOOLS
I. ORGANIZATION NAME:
Troop/Pack/Den Number
II. DESCRIPTION OF ACTIVITY:
III. HIGH SCHOOL
1st Choice:
2nd Choice:
______
IV. USE DATE(S)
List dates and times to be used: (Form must be
submitted a minimum of 15 working days prior to event)
Date: ______ Day:__________
Times: In_______ Out________ Show________
3rd Choice:
Date: ______ Day:__________
Times: In_______ Out________ Show________
Note: There are
application and building
use fees for nonschool
permit holders.
Date: ______ Day:__________
Times: In_______ Out________ Show________
Date: ______ Day:__________
Times: In_______ Out________ Show________
Date: ______ Day:__________
Times: In_______ Out________ Show________
Date: ______ Day:__________
Times: In_______ Out________ Show________
Date: ______ Day:__________
Est. # Of Participants
V. ROOM NEED(S):
Please list all rooms needed.
o Auditorium
o Little Theater
o Lobby/Hallway
o Cafeteria
o Dressing Room (B)____
o Dressing Room (G)____
o Make-Up Room __________
o Room # __________
o Room # __________
o Room # __________
o Room # __________
o Room # __________
o Room # __________
o Room # __________
o Room # __________
o Other
Times: In_______ Out________ Show________
Your auditorium fees cover the cost of the:
Ø Auditorium Supervisor, who will turn on house and work lights, open the
sound booth, storage areas and dressing rooms and insure the safe use
of the facility.
Ø Use of the P.A. system, work lights on stage, house lights, microphone,
and podium.
EQUIPMENT NEEDS: Use separate sheet if necessary
PERMIT MUST BE COMPLETELY FILLED OUT (FRONT AND BACK) AND RETURNED WITH THE APPLICATION FEE
OR
IT WILL BE RETURNED WITHOUT PROCESSING!
OFFICE USE ONLY:
Application fee paid: $
Cash Rec #
Check #
Init:
Date:
Make checks payable to: LIVONIA PUBLIC SCHOOLS
* Livonia Public Schools and PTA’s are exempt from the $25/$40 application fee
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USE OF THE CHURCHILL AUDITORIUM
(Please call our Stage Manager a minimum of two weeks before your first use date at
734.744-2650 ext 46179.)
Dear Prospective Permit Holder:
The auditorium is a specialized facility that requires qualified and knowledgeable users. A
Livonia Public Schools Auditorium Supervisor will be in attendance whenever the auditorium is
used for rehearsals, set-ups or performances.
This individual’s duties are to:
Go over the Rules and Regulations and contract times of the facility usage.
Turn on worklights, houselights, open sound booth and other contracted areas.
Supervise the safe use of the facility and equipment.
Ensure safe, clean exit of the facility on time with contract.
Note: No participants will be allowed into the facility without the supervisor or stage
manager present.
Please check and sign one of the following sections:
 I (Permit Holder) only need the basics: (Use of the P.A. System, work lights on stage,
house lights, microphone, and podium). I understand that if I find, upon arrival, that I need to
request additional supplies, tools, equipment or services, I will be charged accordingly. My
requests will be put in writing and co-signed by the Auditorium Supervisor and me.
Signature of Permit Holder:
- or  I (Permit Holder) will hire my own stage manager. This individual will be qualified for this
position, and will be in my employ. I assume all responsibility for the actions of my stage
manager, performers and guests. This individual will meet on site with the Auditorium
Supervisor before the first requested use date.
Signature of Permit Holder:
Your stage manager is responsible for the following:
q
q
q
q
q
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q
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Must be knowledgeable of all aspects of stage production: Use all systems, safety standards, in charge
of your set-up and strike.
Must be present whenever your group is in attendance. Must be the first to arrive and the last to leave.
Must be responsible for stage crew training and activities.
Has full control of the rehearsals and performance timing.
Must be closely involved in the technical set-up.
Is responsible for the professional behavior of staff and performers while on stage.
Works closely with the Livonia Public Schools Auditorium Supervisor.
Assists in the final clean up of the auditorium and other rooms used.
EQUIPMENT NEEDS LIST:
EQUIPMENT ITEM
The PA, house lights, work lighting on stage, microphone, podium, auditorium
seating and parking lot.
These are standard expectations for a basic rental.
CHARGE
Included in the Usage Fee
Screen and slide projector w/patch cord
To be determined
Additional Microphones
To be determined
Sound Board (Will need a crew person)
$6.50/hour
Follow-Spot lights (Will need a technician/per spot)
$6.50/hour/spot
Acoustical shell and ceilings
To be determined
Grand Piano and/or upright
$75.00/use
Video Taping Equipment
$75.00/use
Stage Chairs (Set-up and striking)
To be determined
Music Stands
To be determined
Music Stand lights
To be determined
Strobe Lights
To be determined
Black lights
To be determined
Overhead/color lighting
To be determined
Risers (Set-up and striking)/Band or Chorus
$100/use
Mirror ball
To be determined
Stage Techs
$20/hr/tech
LPS Scenery
To be determined
Tables in the House
To be determined
Cyclorama (Light blue background)
To be determined
Scenery to fly
To be determined
Custodial Overtime may be charged for extra cleanup AND will be charged as follows:
Time and a Half: Before 7 a.m. and after 10 p.m. Monday – Friday
Before 7 a.m. and after 3 p.m. Saturdays
Double Time: Any time after Saturday Midnight to 7:00 a.m. Monday
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