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. ' J • <br /> 7' Bus. Phone <br /> Name Home Phone 7-✓ <br /> Address, Date <br /> Name of Group or Organization <br /> Intended Use <br /> Date(s) wanted Day(t u :M T W Th F Sa (circle) <br /> C/ <br /> Build' <br /> !.ng- <br /> High chool <br /> 'S Auditorium <br /> — <br /> —Park View*Community' Center. Cafeteria <br /> Wilshire Pa.rk,,'EIe'7 School Classroom(s) # <br /> Othe r ") <br /> Gymnasium (If High School, circle one: <br /> = :" :L <br /> OLD NEW <br /> Kitchen <br /> Other <br /> Doors toopen am _pm Expected attendance: <br /> 'Activity begins —am —prn Admission: —Free Charge <br /> Activity ends am. pm Will merchandise be sold? <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 for giving <br /> any and all i6ithictions to the custodians ofoffier'suppbrt 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 /> . ...... ... <br /> (signature of responsible persovj/ <br /> Bill to: <br /> (name). (address) <br />---------------------------------------------FOR OFFICE USE ONLY------------------------------------------------- <br /> Class Ins Approved by A­ Date <br /> 7. <br /> Charges: Rental Custodial • <br /> Cooks Other charges: <br /> Note: C <br /> f xbf <br /> WHITE—community services office copy CANARY—Business 01fice Copy PINK—Cusloctlene Copy GOLD—Applicenre Copy <br />