Property Services Department
820 Roosevelt Road
Machesney Park, IL 61115
Harlem Consolidated School District No. 122
Facility Request

 Contact: Nicole Silletti
Phone (815) 654-4643
Fax (815) 639-2306
Email Nicole.Silletti@harlem122.org
Organization: Street Address:
Contact/Representative: City/State/Zip:
Phone Number: Activity:
E-mail Address: On-Site Supervisor from Organization:
Cell Phone Number:
Please upload Certificate of Insurance
Event Information
Select Facility or School Requested:
Select Room or Areas:
Enter a valid time range using the HH:MM format to
Special Equipment or Set-Up Required Before Event:
* Will Have Concessions - please check box:
Comments:
Please select all of the date(s) for these time/locations from the calendar below and then click Add Dates.

    • All school gymnasiums are equipped with an AED (Automatic External Defibrillator) - These units are located near or in a hallway by a gym entrance.
    View the Emergency Medical Response Procedure Policies.

    School Functions Have First Priority

    Every effort is made to avoid conflicts in scheduling, however; should a school event be scheduled after approval is received, you will be asked to use
    another facility if available or cancel your activity for that date. SUNDAY requests must have School Board approval.
    Conditions:
    1. Must have a certificate of Insurance naming Harlem School District #122 as additionally insured.
    2. All Groups must supply adequate supervision to ensure proper care and use of school facilities.
    3. NO SMOKING IN THE SCHOOL FACILITIES OR ON SCHOOL GROUNDS.    		4. View the School District's General Rules and Regulations on facility usage.
    5. Harlem Fan's Club has first option to provide concessions.*
    6. View additional Procedures for Use of School Facilities. Signature accepting terms and conditions and acknowleging receipt of this form is required prior to submitting this Facility Request Approval.