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4.r - t•` d. e` :`=-y .s --.,ti i '`-�Ir�ttivi. 'aft `fir •—• o 5_^a a <br /> INDEPENDENT SCHOOL.DISTRICT NO: 282 - <br /> . '` Community Service's Department <br /> - - 3301 Silver Lake Rd-• St. Anthony, Mi SS418 a Phone: 781-5021.-- .'. <br /> - Facilities Reservation Form'-- - - Permit No. <br /> Name,' a �•r���— rim,,.,-sue Home Phone us. Phone <br /> Address v r3/- _ ;L�J � Date ` <br /> Name of Group or Organiiation <br /> Intended Use •�4 _ <br /> Date(s)wanted -1 ' Z n Day(s) Ski•M T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center Cafeteria <br /> Wilshire Park Elem. S C 001 Classroom(s) # <br /> Other , - .!r-"� �� Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: !� <br /> Activity begins _am pm Admission: Free Charge <br /> •Activity ends am L•. 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 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 /> _ Bill to: <br /> 1 (name) (address) <br /> -------_�=-- -----------------------=--FOR OFFICE USE ONLY ------ ------- <br /> Class'- Ins Approved by �r Date <br /> Charges Rental' <br /> .. �. h�/a�,�.r t .•,F- _ z oasa,� -fir:+-.T :..�.., _- �.. f� sue+- '� .• p� <br /> _�'� <br /> •�� <br /> �,. �'t '.�;�'^ �l�y�}'� ;,yj�.�y� a•c Yom,Jjf _ <br /> w'M't�' .,�.,s ar.. • 4:E. .,.tozr•Xr „}. •'-'c�A.rAs <br /> _ q� i..,�s;:^. �'i ,....- - _T�:!_ ,�..°.-1,�^a�� :6twi..-:a ,.;.._ •f-+� "t te'�t .:a� <br /> ttilfTt �-_. -- Of/0�COV/� QIMO�hV/ QOLp�Aptap�,ry car..' -�i ,r� <br /> �.-.. - - •� <..ttQ?.�`S _._ �',__ :�"�=��,_,1.�.-�..:.3 _-- °��i.�_ 'Y':�'� � �„���cew��^°esti+-x�� _�Ss�-ms's-_-f''t. - <br />