Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282. .Community Services Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 • Phone: 781-502.1 <br /> Facilities Reservation Form Permit No. <br /> Name i ' ' Home Phone A �� Bus: Phone �' 7 <br /> IJ <br /> Address - ,.. ,�, �- r�r�> �_ �� Today's Date <br /> Name of Group or Organization '1,77 `' I <br /> Intended Use <br /> Date(s) wanted a1 f �TJ ;1 Day(s)�u)M T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria <br /> Wilshire Park Elem. School Classroom(s) # <br /> —�Other `' <br /> •..�'���+ -'� �' I �,•� �+�h Gymnasium (If High School, circle one: <br /> �C �:. .c C- r.l . LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: <br /> Activitybegins am . pm Admission: <br /> —,LFree Charge <br /> Activity ends am _pm Will merchandise be.sold? _ 442 <br /> Special 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 I will be solely responsible forgiving <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 /> (signatwe of responsible person) <br /> Bill to: <br /> (name) (address) <br />--------------------------------------------FOR OFFICE USE ONLY------------------------------------- -- <br /> Class Ins Approved bye '� + Date <br /> Charges: Rental Custodial <br /> Cooks Other charges: <br /> Note: <br /> WNRE—Comprj Iy Services OHim copy CANARY—Busine"ofrioo Copy PINK—Cusbdlsn?Crmny GOLD—AppNomrs Copy <br />