Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> 3301.Silver Lake Rd o St. Anthony, MN 55418 o Phone: 781-5021 <br /> Facilities Reservation Form Permit No. <br /> • Name _�� �/� r "��C�t Cl I Home Phone Bus. Phone - v <br /> Address _ � c� ��l�Y�.rU"1 1 br ; Date 0 Z,?7 <br /> Name of Group or Organization <br /> Intended Use <br /> C <br /> Date(s) wanted __ ��/�(l1'�( L. <br /> Days Su T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center Cafeteria <br /> Wilshire Park Elem. School Classroom(s) # _ <br /> --Other _ Gymnasium (if High Schocl. circle one: <br /> OLD NEW ) <br /> Kitchen <br /> Other <br /> Doorstoopen am __pm Expected attendance: <br /> Activity begins _ am do pm Admission: __ Free Charge <br /> Activity ends am �J U pm Will merchandise be sold? <br /> • Special arrangements needed (chairs. cooks, AV equipment, etc.): <br /> I hereby certify that I am an agent of the above named group or organization and am authorized to accept in their <br /> name the responsibility for observance of the rules and regulations of the Board of Education, Independent School <br /> District #282.'As a group or organizational agent, I will attend this function,and I will be solely responsible forgiving <br /> any and all instructions to the custodians or other support personnel.Presentation of this permit to the custodian on <br /> duty is necessary for admittance for the initial date. In accepting this arrangement, rentee agrees to hold harmless <br /> I.S.D. 282 and its representatives from all claims incurred in use of the facility. Rentee waives all rights and claims for <br /> potential damages incurred in this rental arrangement. <br /> c Oct_ <br /> (signaliure of responsible person) <br /> Bill t0: <br /> (name) (address) <br /> -------------------------------------------FOR OFFICE USE ONLY--------------=---------------------------------- <br /> Clas Ins Ap roved by <br /> Date � <br /> Charges: Rental Custodial <br /> • Cooks Other charges: <br /> Note: <br /> WHITE—Community Services Office Copy CANARY—6uXIn**s ONloe Copy PINK—Custodlmn Copy GOLD—Applicant's Copy <br />