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` Facilities Reservation Form ��'^� Permit. ----_--- <br /> Nane i'�' HumeP�one 7 /`v�Bus. Phone <br /> 4Ud,eoo <br /> Vate <br /> ~ <br /> Name of Group orOrganization <br /> |nlenuodUse <br /> ` <br /> Date(s) wanted <br /> Day(s) Su KX T VV Th F Sa -(circle) <br /> Building: <br /> | <br /> —High School -___Auditorium � <br /> _-__purk View Community Center —Cafeteria � <br /> —Wilshire Pur* B em. School '�- _----C!aaoroonVs # <br /> —Other --__'Gymnasium (if High School, circle one: <br /> OLD NEW <br /> --__'Kitchen <br /> ^ <br /> —Other <br /> Doumuoopon --�__�_am �--___pm Expected attendance: � <br /> Activity begins _��=_-am pm Admission: ---" <br /> � / Charge <br /> Activity ends am pm Will merchandise be sold? � <br /> Special arrangements neod�d (cA / cooks. equipment, etc.): <br /> ^ ars. cuo s� oqupmon . <br /> . ' <br /> | hereby ce/h/y!hat | annan agent of the above named group n,organization and om authorized to accept intheir <br /> name the responsibility for observance of the rules and regulations of the Boa:rd of Education, Independent School <br /> District #282. Aom group mr organizational agent, I will attend this function,and I will besolely responsible for�hHmg <br /> any and aU � <br /> ins1ruc|!mno1o �heous��dianmorn�hermuppupersonne[ PnamentaUmmofMhimpern|l to the sustqd|enmo <br /> duty is necessary for admittance for the initial date. In accepting this arrangement, rontee agrees tohold hynniens <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 /> ' <br /> ' (uono/u.rm responsible person) <br /> BU/ to: <br /> . <br /> (name) (address) <br /> � <br /> ________________----_--_-_--FOR OFFICE USE ONLY------------------------------------- <br /> ------ <br /> C|axs -^�' |na _-_-_- Approved Date <br /> Charges. ' <br /> � Custodial <br /> � <br /> Cooks <br /> Other charges: <br /> Note: <br /> WHITE-Community Sorvic"O"Ice Copy cANAo,-Bu"inoagortice Copy nNK-Cuamdians C-*py GOLD Applicant's Copy <br />