Laserfiche WebLink
IP <br /> INDEPENDENT SCHOOL DISTRICT NO. 282 r� (rJ 3 " U <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 • Phone: 781-5021 ` <br /> • Facilities Reservation Form Permit No. f` <br /> Name } 16e-r l Home Phone 0 Bus. Phone 1 r r <br /> Address ; J"2 ( '(70 i f �Z Date V- 0 7v J <br /> Name of Group or Organization <br /> �1 l <br /> Intended Use r .v f <br /> 1 _ - <br /> Date(s) wanted ) �' "�- Z SS`J Day(s��' M T W Th F(Sa ( ircle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center Cafeteria <br /> WilshireTark Elem. Schoo� ► Classroom(s) # <br /> Other ( 'U 0-I n 1 �' r'r.f<L �J��/�� 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 Z pm Admission: Free Charge <br /> Activity ends am pm Will merchandise be sold? �U <br /> • <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.Prese alTon of this permit to the custodian on <br /> duty is necessary for admittance for the initial date. In accepting this arr gement,r me agrees to hold harmless <br /> I.S.D. 282 and its representatives from all claims incurred in use of the fa , lity. Reptee waives all rights and claims for <br /> potential damages incurred in this rental arrangement. I <br /> (signature of responsible person) <br /> Bill to: <br /> (name) (address) <br /> ---=------------------------------------------FOR. OFFICE USE ONLY ---------------------------- <br /> Class Ins Approved by Date <br /> • Charges: Rental Custodial <br /> Cooks -Other charges: <br /> Note: <br /> WHIT!—CommurAty,Somicu Office Copy CANARY—SwIrms OM 6 Copy PINK—C nWowks Copy GOLD—Appl mft Copy <br />