Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 2.82 <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony,-MN 55418 • Phone: 781-5021 <br /> Facilities Reservation.Form Permit No. <br /> Name ( r't k t r� Home P. nee' ��~Bus..Phone • <br /> �( °t :l l �'` ' 1 l_;..)Ct.t:t l�i \':i t <t;° 1� !'. _ r ► r .. -r <br /> Address + Today's Date <br /> Name of Group or Organization (`,i +"•- 1 t; i < < �_ r'i+; <br /> Intended Use ` .i.���. _r"t if T <br /> ( ) }F ( - t.� � �..s Jf'� � � Da s Su M T W~1Th F Sa <br /> Dates wanted %� y( ) (circle) <br /> J ' <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria <br /> Wilshire Park Elem. School Classrooms) # <br /> �J Othery'� Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> C <br /> Doors to open am am Expected attendance: r <br /> Activity begins am pm Admission: Free Charge <br /> Activity ends am 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 facill Rentee waives all rights and claims for <br /> potential damages incurred in this rental arrangement. <br /> (signaturt/of responsi le person) <br /> Bill to: <br /> (name) (address) <br />---------------------------------------------FOR OFFICE USE ONLY-------------------------------------------------- <br /> Class Ins Approved by <br /> .✓ -'Date--_� <br /> Charges: Rental Custodial <br /> Cooks Other charges: j • <br /> Note: <br /> WHITE—Ccmmu/n(ty Sinrices Office Copy CANARY—Business Ofeee Copy PINK—Custodians Copy GOLD—Applicant's Copy <br />