Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> 3301 Silver Lake Rd a St. Anthony, MN 55418 9 Phone: 781-5021 <br /> Facilities Reservation Form Permit No', <br /> --dVame I�f i<< i m 2- � � Home Phone Bus. Phone aU <br /> Address �� /y A4��S Date Jr 2 v- Y7 <br /> Name of Group or Organization <br /> Intended UseO L� <br /> Date(s) wanted Ace, `u'f O / Day(s) Su M T W Th (circle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center Cafeteria <br /> Wilshire Park Elem. School Classroom(s) # <br /> Other Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> Kitchen /r.�k,A( 11 <br /> Other ll,� <br /> Doors to open am _ pm Expected attendance: '—l <br /> Activity begins ram pm Admission: Free Charge <br /> Activity ends am "00 pm Will merchandise be sold? A <br /> • >pecial 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 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 re ible person) <br /> 4 <br /> Bill to: AD'" <br /> (name) (address) <br /> --------------------------------------------FOR OFFICE USE ONLY------------------------------------------------- <br /> Class Ins Approved by Date <br /> Charges: Rental Custodial <br /> Cooks Other charges: <br /> Note: <br /> WHITE—Community Services Office Copy CANARY—Business Oltlee Copy PINK—Custodians Copy GOLD—Applicant's Copy <br />