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�=: <br /> INDEPENDENT SCHOOL DISTRICT NO, 282 ` <br /> Community Services Department <br /> 3301 Silver Lake Rd 9 St. Anthony, MN 55418 9 Phone: 781-5021 <br /> Facilities Reservation Form Permit <br /> Name - <br /> Address �' ^ Oo1m <br /> Name of Group Organization <br /> intended Use � <br /> Date(s) wanted Day(s) Su K�'T jW Th F Sa (circle) <br /> Building: - <br /> -High School __-_Audi1oriunm <br /> -Park View Community Center -Cafeteria <br /> Wilshire Park Elem. School . c�|oosnoonn(o) # <br /> _--_ � \ . -_--- <br /> ----_Other �~ -_-_-Gymnasium (|f High Sohoo|, oinc|o one: <br /> ' OLD NEW <br /> -----Kitchen <br /> -Other <br /> Doors to open -am _pm Expected attendance: <br /> _ <br /> Activity begins --_-__am prn Admiosion: __----Free Charge <br /> ' - - - - <br />' <br /> Activity ends __-_-�on` prn Will merchandise be sold. <br /> . <br /> ' Spaoia| arrangements needed <nhairo. cooks, AV equipment, eb:j: <br /> - <br /> ' <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 ihi function,andU will be solely responsible for ivH <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 air,1�ngem,�nt;-FE�� e agrees to hold harmless <br /> all ~'~ '~~^'^x '' <br /> potential damages incurred in this rental arrangement. <br /> (signature of responsible person) <br /> Bill to: <br /> (name) <auumn$ <br /> -_-_-----__-----_---_--_-----------FOR OFFICE USE ONLY'-------------------- <br /> C|ass ---_-- Ins Approved by Date <br /> Changes: RanCo| Custodial <br /> ---Cooks Other charges: <br /> Note' <br /> � <br /> wone-mmm"mty ServIces Office Copy CAw^RY-wusi=ss Once Copy PINK-Custodians Copy GOLD-Applicant's Cop <br />