Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282 <br /> Community Services Department <br /> 3301 Silver Lake Rd • St. Anthony, MN 55418 0 Phone: 781-5021 <br /> Facilities Reservation Form Permit No. <br /> Name r` L +` S�i. LCJLIr GP ! ��=-� Home Phone �� u "Z�>>Bus. Phone <br /> Address . r �� r'�?- Today's Date �� / `7 <br /> Name of Group or Organization Lel L)iZ;e <br /> Intended Use <br /> Date(s) wanted r I + Day(s) Su M T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria. <br /> Wilshire Park Elem. School Classroom(s) # <br /> _Other Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: 100 <br /> Activity begins am e pm Admission: Free, Charge <br /> Activity ends am )Opm Will merchandise be sold? �1 C <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 /> (signaturT-fof responsible person) <br /> Bill to: ' <br /> (name) (address) <br />---------------------------------------------- <br /> FOR OFFICE USE ONLY------------------------------------------------- <br /> Class Ins Approved by Date <br /> Charges: Rental Custodial <br /> Cooks Other charges: • <br /> ? 1 <br /> Note: c :► r°r ,rte. - '. _;Z-� .:, _ <br /> WHITE—Community Services Office Copy CANARY—Business Office Copy PINK—Custodians Copy GOLD—Applicant's Copy <br />