A Certificate of Insurance must be provided along with this application. Red Bluff Union Elementary School District must be named as additional insured.
Statement of Applicant:
I, the undersigned agree by my completing this form, that I am an authorized agent/representative for the requesting agency, and further agree that the rules and regulations set forth under Administrative Regulation 1330 will be complied with in full. I further agree that I am at least 21 years of age and am responsible to the school district for the use and care of the school property. I further agree that the nature of the activity will conform to that stated in the application. I agree to indemnify and hold harmless the Red Bluff Union Elementary School District, its officers, agents and employees against any and all loss, damage and/or liability that may be suffered or incurred by the school district, its officers, agents, and employees.
I, the undersigned, further state that, to the best of my 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 I am making application of use of school property, does not, to the best of my knowledge, advocate the overthrow of the government of the United States or the Stat of California by force, violence, or other unlawful means, and that, to the best of my knowledge, it is not a Communist action organization or Communist front organization required by law to be registered with the Attorney General of the United States. This statement is made under penalties of perjury (per California Education Code section 38136)
