Haverhill Public Schools
Use of Facilities Form
Boston church of Christ
Please Print
| Name of Organization: | Boston church of Christ |
|---|
| Name of Representative: | Annie Rivera |
|---|
| Address: | 214 Concord Street Framingham MA 01701 |
|---|
| Date Requested: | 09/25/2026 Sunday 12/13/26 |
|---|
| Arrival Time: | 8:30 am 8AM |
|---|
| Start Time of Event: | 10 am |
|---|
| End Time of Event: | 12 pm, with “:30” added by hand |
|---|
Please check: ( ) Profit Making Group (XX) Non-Profit Group # 042-494-881
Please check off the location requested and attach list of equipment to be brought into the
facility.
| Gym | #of Classroom(s) | Cafeteria | Auditorium | Library | Fields | Computer Lab |
|---|
| 2 X | | xx | | | |
Written under the table: NOT AWING - MUST USE RWING
| Expected Number of Participants:# | 150 |
|---|
| Type of Event: | Church Service |
|---|
To be filled out by HPS facilities only
| Item | Base Fee | Hours | Sub Total | Total | Additional Info |
|---|
| Rental Fee | $ 210 | 3.5 | $ | $ | |
|---|
| Security | $ — | — | $ | $ | |
|---|
| Custodial | $ 45 | 4.5 | $ | $ | Custodial staff work 30 minutes before and after event. |
|---|
| Utilities | $ 20 | 3.5 | $ | $ | |
|---|
| Lighting Panel | $ 30 | | $ | $ | |
|---|
| Cafeteria | $ | | $ | $ | |
|---|
| Subtotal | |
|---|
| Processing Fee | $10.00 |
|---|
| Balance Due | |
|---|
| Signature of Representative | |
|---|
| Date Requested | 09/25/2026 |
|---|
| Signature of Principal | |
|---|
Principal Authorization: Approved (✓) Denied ( )
School Committee : Approved ( ) Denied ( )
| HPS FACILITIES | PHONE | WEB |
|---|
| 4 Summer Street, Room 104, Haverhill, MA | 978-374-5725 | haverhill-ps.org |
Haverhill Hammers
Written in the top margin: PenLake
Please Print
| Name of Organization: | Haverhill Hammers, opens in a new tab |
|---|
| Name of Representative: | Joe DelGrosso |
|---|
| Address: | 7 Lawton ST |
|---|
| Date Requested: | Nov 9th - Feb 25th |
|---|
| Arrival Time: | 6:00 PM |
|---|
| Start Time of Event: | 6:00 PM |
|---|
| End Time of Event: | 8:00 PM |
|---|
Written under the date: Mon, Tues, Thursdays
Please check: ( ) Profit Making Group (✓) Non-Profit Group #____________________
Please check off the location requested and attach list of equipment to be brought into the
facility.
| Gym | #of Classroom(s) | Cafeteria | Auditorium | Library | Fields | Computer Lab |
|---|
| ✓ | | | | | | |
| Expected Number of Participants:# | 100 |
|---|
| Type of Event: | wrestling practice |
|---|
To be filled out by HPS facilities only
| Item | Base Fee | Hours | Sub Total | Total | Additional Info |
|---|
| Rental Fee | $ 2000 | | $ | $ | |
|---|
| Security | $ | | $ | $ | |
|---|
| Custodial | $ | | $ | $ | Custodial staff work 30 minutes before and after event. |
|---|
| Utilities | $ | | $ | $ | |
|---|
| Lighting Panel | $ | | $ | $ | |
|---|
| Cafeteria | $ | | $ | $ | |
|---|
| Subtotal | |
|---|
| Processing Fee | $10.00 |
|---|
| Balance Due | |
|---|
| Signature of Representative | |
|---|
| Date Requested | |
|---|
| Signature of Principal | |
|---|
Principal Authorization: Approved (✓) Denied ( )
School Committee : Approved ( ) Denied ( )
| HPS FACILITIES | PHONE | WEB |
|---|
| 4 Summer Street, Room 104, Haverhill, MA | 978-374-5725 | haverhill-ps.org |
American Red Cross
Please Print
| Name of Organization: | American Red Cross, opens in a new tab |
|---|
| Name of Representative: | Lynne Connor |
|---|
| Address: | 180 Rustcraft Rd Dedham, MA 02026 |
|---|
| Date Requested: | November 21, 2026 |
|---|
| Arrival Time: | 8am |
|---|
| Start Time of Event: | 9am |
|---|
| End Time of Event: | 3PM |
|---|
Please check: ( ) Profit Making Group (X) Non-Profit Group #____________________
Please check off the location requested and attach list of equipment to be brought into the
facility.
| Gym | #of Classroom(s) | Cafeteria | Auditorium | Library | Fields | Computer Lab |
|---|
| X | | | | | | |
| Expected Number of Participants:# | 60 |
|---|
| Type of Event: | In Memory of Diamond Tincher Blood Drive |
|---|
To be filled out by HPS facilities only
| Item | Base Fee | Hours | Sub Total | Total | Additional Info |
|---|
| Rental Fee | $ 75 | hr | $ | $ | |
|---|
| Security | $ | | $ | $ | |
|---|
| Custodial | $ | | $ | $ | Custodial staff work 30 minutes before and after event. |
|---|
| Utilities | $ | | $ | $ | |
|---|
| Lighting Panel | $ | | $ | $ | |
|---|
| Cafeteria | $ | | $ | $ | |
|---|
| Subtotal | |
|---|
| Processing Fee | $10.00 |
|---|
| Balance Due | |
|---|
| Signature of Representative | Lynne Connor |
|---|
| Date Requested | |
|---|
| Signature of Principal | |
|---|
Principal Authorization: Approved ( ) Denied ( )
School Committee : Approved ( ) Denied ( )
| HPS FACILITIES | PHONE | WEB |
|---|
| 4 Summer Street, Room 104, Haverhill, MA | 978-374-5725 | haverhill-ps.org |
- Use of Facilities Form, Boston church of Christ, PDF, one page, opens in a new tab
- Use of Facilities Form, Haverhill Hammers, PDF, one page, opens in a new tab
- Use of Facilities Form, American Red Cross, PDF, one page, opens in a new tab
