Laserfiche WebLink
NDUJIMH FICT <br /> Mw/Lar Ad• SL 111 Mw M 55416 a Maw 7f 4MM <br /> pidolii Form faennit No: Q�[ <br /> Name *'� _ _;--- _ ,® � ,�. <br /> Address Ij j �`t��-� :r. DatA ... <br /> Name of Group or OrpanitatW <br />.. ..._ - - ..are•- ,•aw r`r� .+. .... .. .. •.� - . �,�. - ->�;�:;_. •+,.ra•,., .�r,-s�„tits:. - <br /> Intended Use C,1114 <br /> f: Qtl!tessl wansffd Oaa� M,T Y�Y:T <br /> Sam •t°r, °r r � ..+� :-`+c- try's s --- -- - ... _. i S _ <br /> Building: <br /> High School Auditorium <br />;��*� - Park.View• � e�`syv� !�-. CalAbAafe:�-=.�-��:��f:-�����: �++1-�li� <br /> Wilshire Park Elem. School Classrooms) N <br /> =Other '-^r A,_i it F-1, L r_l�r��r I, ( Gymnasium (If High School, circle one: <br /> r OLD NEW ) <br /> Kitchen <br /> ._ Other . <br /> Doors to open am m Expected attendance: <br /> Activity begins am pm Admission: Free Charge <br /> �,r,, ctivity ends am li,W pm Will merchandise be sold? <br /> l� 0 <br /> oppecial arrangements needed (chairs, cooks, AV equipment, etc.): ; <br /> C <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,l 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 Mal 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 /> I <br /> (signature of responsible person) <br /> Bill to: - <br /> (nama) (address) .L. <br />•----- --- - .. • . a. _ FOR OFFICE USE-ONLY <br /> Ins Approved by _ —1� <br /> Class In r` Date <br /> Charges: Rental - ���, Custodial t <br /> :� ���` CooRa. ,"r. �`'"..4 a i.:t-•�"f"ai•'v�`+.i�, - I''ky� �.�..p-•�Y s �_ yMr�a�§ � � 7C. M ��,- °. <br /> ' A” <br /> • `'r ',�i+/: .* •_ - �'LZ�r f }: •�,_ T•f-;� '• d. 't:I, .ter. .. .v;-.nr - �_ <br /> Note: <br /> WM M—GEMOMM awubw ON"COW CAMM Y—Madna 011ke Celt P1MM—Mb1111ene CWY OMD—Amts-'s cwtf <br />