Set-Up Worksheet (Form 012007)
Room Reserved: □ Stone Center □ Board Room
1. Person responsible: _____________________ Phone: ___________________
2. Name of program: _______________________________________
3. Date(s) of program: _____________________
4. Starting time of reservation: _______ am/pm
5. Starting time of program: _______ am/pm
6. Ending time of reservation: _______am/pm
____ Number of Tables (each table accommodates 8 chairs)
____ With linens at $3 each
____ Number of Chairs (only)
_____Custodial Services Will be Billed at $15.23 per Hr. – per custodian
How should the room be arranged? [Please include diagram on back.]
7. □ Yes □ No Will you need the microphones, lighting and sound board? ($21.32 per hour)
□ Microphones □ Lighting □ Sound Board
8. □ Yes □ No Will you need the divider closed?
9. □ Yes □ No Will you need both sides of the room?
10. □ Yes □ No Will computers need to be hooked to the projectors?
□Front □Back □Both
11. □ Yes □ No Will you need the DVD players?
□Front □Back □Both
12. □ Yes □ No Will you need the speaker’s podium?
Place podium(s) □stage □floor □ Board Room
Any additional equipment [overheads, VCR, cables, etc] must be arranged through Tech.
13. □ Yes □ No Is food being served
14. □ Yes □ No Is the event being catered.
15. Name and phone number of the person catering ? ________________
16. □ Yes □ No Will you be providing your own center pieces?
17. □ Yes □ No Will you need gate opened for access to handicap ramp for Stone Center?
18. □ Yes □ No Responsible party agrees to return the facility in the same condition it was found?
19. When any additional decorations are being used there is to be no tape of any kind attached to the walls, post or columns in the Stone Center.
20. All art work is to be left in place.
21. All props/costumes, etc. must be removed from the premises within 48 hours following your performance.
22. Any changes made after set-up sheet has been completed should be communicated to Melissa Shepherd or Janet Staley.
23. This Set-Up Sheet must be completed and returned two weeks prior to your event.
Responsible party agrees to maintain the facility in a clean and orderly manner and shall return to officials in the same condition as when received. User accepts full responsibility for any personal injury or property damage which may occur during the time period of use of the facility. Wilkes County School Systems is not liable for any personal injury or loss of personal possessions.
Signature: _____________________________ Date: ________________
Mailing Address: ______________________________________________
Please return completed form to Melissa Shepherd – Fax: 336-667-5607
(Form 012007)(Revised 7-13-10