Laserfiche WebLink
6 ' <br /> INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 • Phone: 781-5021 <br /> a�i, Ao Facilities Reservation Form Permit No. <br /> Name ,C}�k i -> • 1_C%Ct 1� Home Phone 02 1Bus. Phone /P"2— 7,7 <br /> Address L1 l Lnky O'k k)0 L Today's Date <br /> Name of Group or Organization -� X. <br /> Intended Use 1 ` <br /> j. <br /> Dates) wanted u9 Day(s) Su M er)W Th F Sa (circle) <br /> Building: <br /> High School Auditorium . <br /> Community Center Cafeteria <br /> Wilshire Park Elem. School , Classroom(s) # <br /> Other —Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: <br /> Activity begins r/.�;'�am <br /> pm Admission: Free Charge <br /> Activity ends am pm Will merchandise be sold? Q <br /> Special arrangements needed (chairs, cooks, AV equipment, etc.): yet LL. L- <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 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_t�a facility.Rentee waives all rights and claims for <br /> potential damages incurred in this rental arrangement. <br /> (signature of responsible person) <br /> Bill to: <br /> (name) (address) <br />---------------------------------------------FO FFICE USE 0 LY--------------------- <br /> -------__-------_____---- <br /> Class Ins Approved by T ti ic Date S 3 V-` <br /> Charges: Rental Custodial <br /> Cooks Other charges: <br /> Note: <br /> WHITE—Commudly Savleh Office copy CANARY—Business Office copy PINK—Cudodlw Copy GOLD—Applkair.Copy <br />