2023/02/27 Santa Rosa Academy Facilities Rental Developing a habit of mind for success through the timeless
principles of excellence, integrity, and respect.
27587 La Piedra Road, Menifee, California 92584 P 951.672.2400 F 951.672.6060
www.sra.mn
BOARD OF
EDUCATION
Scott Mason
President
At-large Member
Kellie Welty
Secretary
Parent Member
Dan Temple
Treasurer
Community Member
Brooke Snell
Parent Member
Eric Russell
Parent Member
Gina Gonzalez
Community Member
Benjamin Diederich
Community Member
SCHOOL
ADMINISTRATION
Robert Hennings, Ed.D.
Executive Director
Aaron Capp
MS/HS Principal
Margie McDairmant
Elementary Principal
Community partner,
Santa Rosa Academy is pleased to offer our premium facilities for use at a
competitive rate. Please look at our rate sheet below and let us know how we can
support your business, or non profit. We are very selective with whom we partner
with, and we expect our partners to adhere to our standards of Excellence, Integrity,
and Respect.
Facility Non-Profit Fair Rental
Classroom $15 $30
Plaza $35 $65
Gym $125 $225
Santa Rosa Room $35 $65
Restroom $8 $16
Baseball Field $50 $100
Soccer/Football Field $125 $225
Parking Lot $5 $10
Library $25 $50
Staffing
Custodial/ Security $35 $60
Overtime Rates $45 $70
NOTE: Applicants must read the rules and regulations, and conditions for use of
school facilities prior to completing this form.
TO BE COMPLETED BY APPLICANT:
(Application must be submitted ten (10) working days prior to first event or use.)
Organization or Individual: ___________________________Date:______________
Represented by (Name and Title):______________________Tax ID#:___________
Non-Profit: Y N
Billing Address:______________________________________________________
Email Address:_______________________________________________________
Phone: ________________________Cell Phone:____________________________
Facility(s) Requested:__________________________________________________
Will be used: Single Use Monthly Other:_____________________
Date(s) Requested:_________________ Purpose or Type of Use:_______________
Date(s) Excluded:___________________ Hours to be used:___________________
Day(s) of the week: M TU W TH F SA SU Donations Solicited: YES NO
Admission/Registration Fee Charged: YES NO Estimated Attendance:________
City of Menifee 8/25/22
Martin Gutierrez, Community Services Coordinator
29995 Evans Rd., Menifee CA 92586
mgutierrez@cityofmenifee.us
951-723-3793 951-746-7823
Gym
1/14/23-3/11/23 Youth Basketball
8am-3pm
300
Weekly
DocuSign Envelope ID: 73FBE4A6-7D75-468C-8C06-E4CBD3885DA1
Developing a habit of mind for success through the timeless
principles of excellence, integrity, and respect.
27587 La Piedra Road, Menifee, California 92584 P 951.672.2400 F 951.672.6060
www.sra.mn
SANTA ROSA ACADEMY RULES AND REGULATIONS & CONDITIONS FOR USE OF FACILITIES
1. Accounting personnel will calculate estimated fees in accordance with the current fee schedule. Amounts not paid
to Santa Rosa Academy within 90 days will be sent to a collection agency or small claims court. Bills not paid on
time shall cause a user to be denied continued use of the facilities until delinquent payments are paid.
2. Verify insurance documentation is appropriate.
3. Registration and supervision of the facilities must be by a responsible adult (21 years of age or older).
4. Tobacco products, alcohol and any controlled substances are not allowed on any school property.
5. Use is confined to the area(s) named in the approved application, with appropriate corridor and lavatory facilities.
Approval of the application does not guarantee exclusive access to the facilities.
6. No materials are to be taped, tacked, stapled, glued or pinned to any surface unless designated for such purpose.
7. All users must provide their own supplies (i.e., easel, easel pad, marking pens, pencils, note paper,etc.).
8. Secretarial and telephone services are not provided.
9. It shall be the responsibility of the group using the building to supervise all participants.
10. Applicants must return the facility to its original arrangement and condition (facility, chairs, tables and white
boards). Any damage caused by the user will be billed to the user.
11. Custodial staff will make periodic inspections of the facility and will interrupt to clean spillage of food and
beverage as necessary. Users will be charged for all custodial costs incurred.
12. Reservation is tentative until Application and Agreement for Use of Facilities form is properly completed and
approved. This cannot occur until an insurance certificate is provided and application form is approved by an
authorized school-level official.
13. Facility users are required to comply with the lawful requirements of the school, the State of California, and all
applicable requirements of the City of Menifee and Riverside County regarding discharges to the storm drain
system and watercourses, including applicable requirements specified in local municipal stormwater management
programs or plans.
AFFIDAVIT IN ACCORDANCE WITH EDUCATION CODE SECTION 38136: The undersigned states that, to the
best of his/her knowledge, the school property for use of which application is hereby made, will not be used for the
commission of any act intended to further any program or movement the purpose of which is to accomplish the overthrow
of the Government of the United States by force, violence or other unlawful means. That , the organization on whose
behalf he/she is making application for use of school property, does not, to the best of his/her knowledge, advocate the
overthrow of the Government of the United States or of the State of California by force, violence, or other unlawful
means, and that, to the best of his/her knowledge it is not a communist-action organization or community-front
organization required by law to be registered with the Attorney General of the United States. This statement is made under
the penalties of perjury. INSURANCE REQUIREMENTS: Santa Rosa Academy requires a Certificate of Insurance, and
if necessary, an endorsement to your insurance policy before your application can be approved. Insurance must be for
Commercial General Liability, with limits not less than $1 million per occurrence. Santa Rosa Academy must be listed as
additional insured. Your insurance agent can provide the required certificate and endorsement. HOLD HARMLESS
AGREEMENT: Applicants hereby agree to hold Santa Rosa Academy, its Governing Board, the individual members
thereof, and all school officers, agents and employees free and harmless from any loss, damage, liability, cost or expense
that may arise during or be caused in any way by such occupancy of school property. The applicant agrees to reimburse
the school for any damage to school property occasioned by or growing out of use herein requested.
I HAVE READ THE RULES AND REGULATIONS, CONDITIONS FOR USE OF FACILITIES AND FEE SCHEDULE
RELATING TO THE USE OF SCHOOL FACILITIES AND ACCEPT RESPONSIBILITY FOR MEETING THE
REQUIREMENTS STATED THEREIN AND FOR PAYING THE BALANCE OF THE ACTUAL FEE UPON RECEIPT OF
INVOICE.
AUTHORIZED SIGNATURE OF APPLICANT:____________________________________ DATE:___________________
DocuSign Envelope ID: 73FBE4A6-7D75-468C-8C06-E4CBD3885DA1
2/27/2023
100-4662-52054
DocuSign Envelope ID: 73FBE4A6-7D75-468C-8C06-E4CBD3885DA1
Developing a habit of mind for success through the timeless
principles of excellence, integrity, and respect.
27587 La Piedra Road, Menifee, California 92584 P 951.672.2400 F 951.672.6060
www.sra.mn
SANTA ROSA ACADEMY APPROVAL:
Approved by Facilities Manager:__________________________________________ Date:________________________
Insurance Certificate received: YES NO N/A Expires on:____________________
Approved by Administrator:_____________________________________________ Date:_________________________
Approved by Executive Director:_________________________________________ Date:_________________________
SANTA ROSA ACADEMY
Staff Member:______________________________________________________________
Time in:___________________________________ Time out:________________________________________
Damage or comments:________________________________________________________________________
(Forward to Business Office at the end of the event)
DocuSign Envelope ID: 73FBE4A6-7D75-468C-8C06-E4CBD3885DA1