Laserfiche WebLink
--rte?- '.•�^"_s '� a ^_'t'� = - <br /> � '' T INDEPENDENT�SC�HOOL DISTRICT NO. 282� <br /> - s� }k° �^� �e� v�T_•,� � -.� :s u-•e.+-x?.r .• �:-�• '' —. <br /> _ Co -,munlh►_Se! ces Cepar"ent ti_ <br /> 330 Ifver Lake Rd <br /> SLAM W ony, MN• •�SS418. Phone 781 5021 <br /> i.dM F-x•"•- •1 Y. q�4. f y 1, Jr fY 'J T �•' "�. -_ - - _ ,._ - .. <br /> Faclllttef%Resertiatlon Form_ _` Permit No. �" <br /> .-.cam x .E�-4I••. <br /> U. �y�t i K..` r a' r_ _ _. -. •. - ` - :" ,``r .- ',.. - <br /> Name' Home Phone Yus: Phone <br /> LAddress f C- Date <br /> � Name ' l Group or Qrganiiation <br /> Intended Use ' ( } rz <br /> 07 <br /> •`, _ _ _ - - <br /> Oate(s)`wanted'.-'- DayO Su' M T W Th F Sa (circle) <br /> _ 4 <br /> Building 5 . 7- <br /> High School: ' - Au itorium <br /> Park Vieti►i.Community Center Cafeteria <br /> Wilshire Park,•.Elem. School 20 Classroom(s) # <br /> Other" —Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> 3 Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: <br /> Activity begins am pm. Admission: Free. Charge' <br /> Activity ends ' - am pm Will merchandise be sold? ` <br /> Special arrangements needed (chairs, cooks, AV equipment, etc.): E 2U 4.–ri—. . t.,�7t7., <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,l will attend this function,and I 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 fa 'lity.Rentea Wale all rights and claims for <br /> potential damages incurred in this rental arrangement. <br /> (signat(,ie�ot_ sponsible person) <br /> l <br /> Bill to: <br /> (name) (address) <br /> ----------------------------------------------FOR OFFICE USE 0(yLY---- ---------------------------- <br /> ---- ------ <br /> Class Auk`'"&' Approved by hoc �` Date C/d <br /> Charges: Rental J ustodial <br /> Cooks_ Other charges: <br /> Note: <br /> r• ' <br /> WNrM Cemmwrtj inn Ic- ottla co" CANA Y—anlmu Oleo COPY PINK—CudDO 4 copy. GOLD—APPOOMI ti COPY <br />