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INDEPENDENT SCHOOL DISTRICT NO. 282 _ <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 • Phone: 781-5021 <br /> Facilities Reservation Form Permit No.�- <br /> Name Home Phone Bus. Phone - <br /> Address �-� Today's Date <br /> Name of Group or 0 r 9 anization <br /> Intended Use <br /> Date(s) wanted Day(s) Su M T W �F Sa (circle) <br /> Building: <br /> t_ <br /> High School Auditorium <br /> • Community Center Cafeteria <br /> Wilshire Park Elem. School Classroom(s) # <br /> le Other I J AL—, Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am . pm Expected attendance: `^ <br /> Activity begins am pm Admission: fit`Free Charge <br /> Activity ends am ti's 2 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 /> (name) (address) <br />---------------------------------------------FOR OFFICE USE _ONLY-----------=------------------__---------------- <br /> Class Ins Approved by `x� ' / �� Date ' �� Y <br /> Charges: Rental Custodial <br /> Cooks Other charges: <br /> Note: <br />