Laserfiche WebLink
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 /> * i �' .- - • <br /> Name ����r/� Home Phone Bus. Phone-­A ' . <br /> Address Date <br /> -. ,. <br /> Name of Group or Organization " ' `t"- Y <br /> Intended Use <br /> Date(s) wanted. Day(s) Su M T W Th (circle) <br /> Building: <br /> High School Auditorium <br /> Park View Community Center Cafeteria <br /> Wilshire P Elern. Sc ol Classroom(s) Of <br /> Other Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> -?F.-. Kitchen /_j <br /> Other 7• tC'�- <br /> Doors to open am pm Expected att nuance: <br /> Activity begins a -pm Admission: Free Charge <br /> Activity ends art.�1rbpm Will merchandise be sold? <br /> Special arrangements needed (chairs, cooks, AV equipment, etc.): • <br /> I hereby'certity that I am an agent of the above named group or organization and am authorized to accept in their <br /> name the resporisibility for observance of the rules and regulations of the Board of Education, Independent School <br /> District f#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 /> ir <br /> Bill to: <br /> (name) (address) <br /> FOR OFFICE USE ONLY ------------------------ <br /> ----- - ------------------ <br />-------------------------------------------- -------------------- <br /> Class Ins Approved by Date <br /> —T <br /> Charges: Rental Custodial <br /> Cooks ` Other charges: • <br /> Note: "� l/moi �- .. ,'RJ.L C' l <, �r �ltr iii <br /> ' ~'4141TE—CornmuNly Service*Office Copy CANAfiT—Sudno.o Office Copy PINK—Cusfedloen Copy GOLD-AppflcMars copy <br />