Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT'NO. 282 <br /> Community Services Department':, - - <br /> 3301 Silver Lake Rd • St. Anthony, MN-,55418 a Phone:-781-5021 <br /> Facilities Reservation.Four Permit No. <br /> Name , �' S�o,e' Home Phone y�78 lZus. Phone <br /> Address °20�" `3 S 1 Today's Date <br /> Name of Group'or Organization �° we m ti T <br /> I 7t <br /> Intended Use C oj/c c_ 4 2 W__j <br /> Date(s) wanted 7 —.2 9S� Day(s) Su M T Wi Tl F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria <br /> Wilshire Park Elem. School Classrooms) # <br /> Other Gymnasium.(If High School. circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: aZ� <br /> Activity begins a pm Admission: Free Charge <br /> Activity.ends .6he.arrt L!-,O- v p Will merchandise be sold? uAp <br /> Sped l arrangements needed (chairs, cooks, AV equipment, etc.): <br /> f <br /> e d es i2o o A4 s a e,J V- e-le e / y o� <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.Preaentatlon 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 u e of the 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 />-_-_- <br /> -------- FOR OFFICE USE ONLY <br /> Class Ins Approved by Date <br /> Charges: Rental Custodial <br /> Cooks Other charges: <br /> Note: <br /> ' :'ti. , ..6it9.�+.:.,:rk. .,�:•""�-!':. '.r:''L•?1:;�dCtiU'tq' :1'• "ic � ' •+'fit:^.�y� <br /> nso-n-s. CAKAR. sk.d----nrr-n­ d.-r-n- nnf n Aw—f1 dmw <br />