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Community Services Department <br /> 3301•S11ver:"l:ake=Rd.• St. Anthony, MN.15418 to•Phone: 781=5021 <br /> t <br /> Facilities Reservation Form Permit No. <br /> y Name Elaine Sandal Home. Phone _78904448 Bus. Phone 540-5992 <br /> 2501 Lawry Ave. N.E. A#45 Mpls. MN 55418 <br /> Address _— Date 7113/84 <br /> Name of Group or Organization _ Fami ly Picnic <br /> Intended Use Picnic <br /> Date(s) wanted Sunday A_ ugust 26 _ Day(s Su M T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center .Cafeteria <br /> Wilshire Park Elerp. Schpol Classroom(s) # <br /> Other en ra I parK_— Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> Kitchen <br /> Other <br /> Doors to open U_am ___7_0Jpm Expected attendance: 40 to 50 <br /> Activity begins —_ am _pm Admission: ----Free Charge <br /> 9 <br /> Activity ends —am _pm Will merchandise be sold? <br /> t <br /> Special arrangements needed (chairs. cooks. AV equipment, etc.): <br /> a <br /> I hereby certify that I am an agent of the above named group or organization and am authorized to accept in their <br /> s name the responsibility for observance of the rules and regulations of the Board of Education, Independent School <br /> District X282. As a group or organizational agent, I will attend this function,and t will be solely responsible for 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 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 /> a <br /> (SignaturB of responsible person) <br /> Bill to: <br /> (name) (address) <br /> q ---------------------------------------------FOR OFFICE USE ONLY---------------------------------------------- <br /> Class Ins Approved by Date r <br /> Charges: Rental A-, Custodial <br /> Cooks Other charges: <br /> Note. <br /> I <br />'. WHITE—Community Services 0111ce Copy CANARY—Business Office Copy PING(—Custodians Copy GOLD—Applicant's Copy <br />