Teacher:

Date Filed: Date of Activity:

Group/Class/Club:

Facility Needed:

Location if Not on Campus:

Starting Time:  Ending Time:

Monthly Activity?  If so, give the day each month that it will occur. (Like first Monday of every month.  Only one form will be needed)  For example, band practice every Monday and Wednesday from August to October or Key Club meets every month on the first Monday.

Description of Activity:

For Office Use

______Approved  ______Disapproved    ___________________Date Added to Calendar

Principal__________________________  Date:____________________

Comments:_______________________________________________________________

_______________________________________________________________________

________________ Activity Cancelled  ______________Activity Date Change    Reason for Cancellation __________________________________________________________

________________Date Changed on Calendar