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INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> ;'01 Silver LFke Rd * st. Anthony, MN s5a i8 • Phone: 761-5021 <br /> .1 ,f <br /> Facilities Reservation Form r-errr,n No <br /> 7 f ' �J r <br /> Name t- r ^--'U✓ i-iome Phone / ¢ _ . Phone <br /> a <br /> ores J C <br /> Ad �7`'sJ �� C.- GC.;✓ '` r�•e - /L � — <br /> Name of Group or on ` <br /> Intended Use <br /> i'-ate(s) %vanied z'-'v_ T 1 7 t7 Dav(s) Su IAA T W Th F (circ;e) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center _ Cafeteria <br /> Wilshirerf ark E!e�+.;moo:*' i _ C)assroorn(s) # <br /> Other Gymnasium (If High School, circle ore: <br /> OLD NEW ) <br /> Kitchen <br /> Other <br /> Doors to open a,., pm Expe::ied attendance: <br /> Activity begins :c-• ✓am —pr r, Admission: Free Charge <br /> Activity ends arr. Will merchandise be sold? <br /> Special arrangements needed (chairs, cooks. AV equipment. etc.): <br /> I hereby certify that I am an agent of the ahcve named group or organization and am authorized to accept in;heir <br /> name the responsibility for observance of the rules and regu!atio-is 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'or giving <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 adni::ance to: the initlai date. In asceptir,y This arrangement, rentee agrees to hold ha:mless <br /> I.S.D. 282 and its representatives from all claims incurred In use of Me facility. Rentee waives all rights and cairns for <br /> potentia! damages incurrezi in this rental arrangement. <br /> (sigore of responsible parson) <br /> Bill to: _ <br /> (,.3mc) (address) — <br /> -------------------------------------------- FOR OFFICE USE ONLY--------------------------------------------- <br /> Class Ins A;•prcv&d by Date 9 °� <br /> Charges: Rental /✓ Custodial <br /> Cooks Other charges: <br /> Note: _ <br />