Laserfiche WebLink
i <br /> ! <br /> INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department i <br /> 3301 Silver Lake Rd a St. Anthony, MN 55418 • Phone: 781-5021 <br /> Facilities Reservation Form Permit No. • i <br /> / ( �► _. <br /> Name ( ���'► Home Phone -Bus. Phone ! <br /> Address > > Date <br /> i <br /> Name of Group or Organization I�an(ff99 <br /> Intended Use <br /> Date(s) wanted —� f� Day(s) Su M T W ThC-' a) (circle) <br /> Building: <br /> —High-School Auditorium <br /> Park 'View Community Center Cafeteria <br /> Wilshir Par Tem. School Classroom(s) #Other Ei 0t 1'J r��r-(� Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> Kitchen- <br /> _V_-Other PAViLUCpl <br /> Doors to open am pm Expected attt cTance: <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.): <br /> I <br /> r I hereby certify that I am an agent of the above named group or organization and am authorized to accept in their <br /> narne the responsibility for observance of the rules and regulations of the Board of Education. Independent School <br /> District 8282. As a group or organizational agent, I will attend this function,and I will be solely responsible for giving <br /> arty 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 /> (signature of responsible person) <br /> i <br /> Bill to: <br /> (name) (address) <br />---------------------------------------------FOR OFFICE USE ONLY ----------------------------------------------- <br /> Class Ins Approved by Date <br /> Charges: Rental Custodial i <br /> Cooks Other charges: ! <br /> i <br /> Note: <br /> i <br /> i <br /> WHITE—Community Services Office Copy CANARY—Business Office Copy PINK—Custodians Copy GOLD—Applicant's Copy <br />