Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 • Phone: 781-5021 <br /> Facilities Reservation Form Permit No. <br /> Warne �1 G r tf'L `'A Home Phone Bus. Phone- ? <br /> Address �4 S c � C f%'T� ( r' �e_ Date <br /> Name of Group or OrganizationC� r'►1 ���► 1'1 1 _ <br /> Intended Use I. C_ VA <br /> Caters) wanted __w:,n 2 Day(s Su rA T W Th F Sa (circle) <br /> Building: <br /> High School Aud::orlum <br /> Park View Community Center Cafeter;a <br /> Wilshire ark Elem. School Classroom(s) # <br /> Other Gymnasium (If High School, circe one: <br /> OLD NEW ) <br /> Kitchen -- <br /> Other <br /> Doors to open am pm Expected attendance: o <br /> Activity begins am S•:50 pm Admission: Free Charge <br /> Activity ends am�'J�pm Will merchandise be sold? C <br /> eSpecial 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 1 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 /> potentia! damages incurred in this rental arrangement. <br /> T(signalure of responsible person) <br /> Bill to: <br /> (name) taa:�ress) <br /> ------------------------------------------- FOR OFFICE USE ONLY------------------------- -----__------ <br /> --, � _ 5 <br /> Class Ins Approved by Date <br /> Charges: Rental ,LJ�_ Custodial <br /> • Cooks Other charges: <br /> Note: <br />