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 /> Name - Home Phone j ° { �`( Bus. Phone f - . L <br /> Address 05 '�-C-- Today's Date <br /> Name of Group or Organization �` <br /> i <br /> If, <br /> Intended Use <br /> Date(s) wanted Day(s) Su M 'T W Th F Sa - (circle) <br /> -- <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria <br /> Wilshire ark EI m. School Classrooms) # <br /> Other 4 �� ;5� Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> —Kitchen. <br /> Other <br /> Doors to open am pm Expected attendance: <br /> Activity begins am pm Admission: Free Charge <br /> Activity ends am 'pm Will merchandise be sold? <br /> tt <br /> Special arrangements needed (chairs, cooks, AV a uipment, etc.): <br /> ti.k r4Z-tm c,.t CL k_;�,, c 0- Lt._ C,vg c � l <br /> i-OuL5 <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 /> (signature of responsible person) <br /> Bill to: <br /> (name) (address) <br /> ---------------------------------------------FOR OFFICE USE ONLY--------------------------- -- -------------- <br /> Class Ins Approved by f-'f • % -L ' — Date �� , I� <br /> Charges: Rental Custodial • <br /> - Cooks Other charges: <br /> Note: <br /> .:,..WHITE—Commudh SonRn OMen Coot..- CANARY—Business OMP Coon PINK Cudoaam Caen GOLD—Aedleanr.Caen. <br />