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In-House Facility Use/Technology Request
Henry Hudson Regional In-House Facility Use Form
Name
*
Today's Date
*
MM
/
DD
/
YYYY
Date and Time of Setup
*
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Check if needed Multiple Days or Specific Periods
List Dates and/or periods in Multiple Days in Box Below.
Multiple Dates and/or Times
Facility Needed
*
Cafetorium
Classroom - Please list below in "Other"
Music Room
Gymnasium
Computer Lab
Media Center
Athletic Field
Compass Area
Other-Please Describe Below in "Other"
Please be specific when checking other. Write Below.
Other
Audio Visual- Technology Equipment
*
Laptop No Sound
Laptop with Sound
LCD Projector with Screen
Microphone
DVD
CD Player
Podium
None
Other-List Below
Please be specific when checking other. Write Below.
Other Equipment Needed (Please specify, ie. piano, stage lights, tables, chairs.
Email
*
Purpose for which facility will be used
Attendance Expected