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.: •.:'�� � �,�^• ,"s, l�> 3- �° •h�" 'i>�.b-n gal"�ra'.r a .y r .-_. � � ' <br /> ° � INDEPENDENT�SCHOOL?DISTRICT NO. <br /> _ ,�+a j ter[, g •3- � 5,.• i- 'F)s�/�� ...wi b w d:� - - s •`•,�- ±._ .fi,,� <br /> .r -r.sv a �L+4�e•s.-s� •e'Sa..; a.Wmmunity"§SenrYces Departments =J:��` <br /> 3301,51rver Lake Rd St. Anthonyr MN �5541fii.• Phone, 781 5021; <br /> %+rT _ ~�.= <br /> FacllttIii Reservatlon Form ` ;,Permit No. <br /> - <br /> - �Namer`' '�� ="r -� t" i�� Home Phoneus: Phone - <br /> << <br /> IR <br /> =Hddress r r C <br /> �7 <br /> Name of Group or_Organization <br /> 'Intended Use <br /> Date(s) wanted �1.�; 9 (3 Day(s) Su M T W Th F Sa (circle) <br /> Building: <br /> High - Auditorium <br /> Park View Community Center _ Cafeteria _ <br /> Wilshire Pa_rk.Elem. School Classroom(s) # <br /> Other- Gymnasium (If High School, circle one: <br /> �► �� . I., a , 3 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 L i:� :• am pm - Will merchandise be sold? <br /> Special arrangements needed (chairs, cooks, AV equipment, etc.)__ �u <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 farA'Iity.Rente ( a all rights and claims for <br /> potential damages incurred in this rental arrangement. ` J • <br /> AYA <br /> `(signat`ie�of. spons' I' person) , <br /> Bill to' \ ' <br /> (name) (address) <br /> --------------------------- ------ <br /> ---------------------- <br /> FOR FFICE USEE�LIG� _ _ - <br /> Class '`fns Approved by 6-*P �, Date C/C <br /> Charges-. Rental~ -'s� , f �� ustodial <br /> _ Cooks _ _ Other charges: <br /> Note: - _•_;;. - _ : .. :- .. - <br /> i ; , • MIME coffan.+ti t ..orna eevtr ei iu�r ri.,�...,omk,eov�r prat-_rcti.�oa�w cal. aoLo=wv�!fti eevr <br /> .° ; <br /> s:s'?';�.. f ~ YJ. :j,. 1- f _ `.A'. a.:-''JL.,�S��i�. .� '.•". �� * � - :Z� fir.-i_. -t.�. ', <br />