Laserfiche WebLink
INDEPENDENT SCHOOL DISTRICT NO. 282 L C <br /> Community P Services Department <br /> 3301 Silver Lake Rd a St. Anthony, MN 55418 • Phone: 781-5021 <br /> Facilities Reservation Form Permit No. <br /> Name of �--f � Home Phone � <~ �gus. Phone <br /> Address i3 ' y e ( Today's Date <br /> Name of.Group or Organization <br /> Intended Use <br /> Date(s) wanted L;1 Day(s)&M T W Th F Sa (circle) <br /> Building: <br /> High School Auditorium <br /> Community Center Cafeteria <br /> Wilshire Park Elem. cool Classrooms) # <br /> Other &=Zn A I t Gymnasium (If High School, circle one: <br /> LARGE SMALL ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: 6Z <br /> Activity begins am pm Admission: Free Charge <br /> Activity ends am � pm Will merchandise be sold? ~� <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 /> (signature of responsible person) <br /> Bill to: <br /> (name) (address) <br />---------------------------------------------FOR OFFICE USE ONLY------------------------------------------------- <br /> �f . <br /> Class Ins Approved by Date ! 1(.� A� <br /> Charges: Rental =_/06 Custodial <br /> 4 Cooks '� Other charges: <br /> Note: <br /> WHITE—Community services Office Copy CANARY—Business Office Copy PINK—Custodians Copy GOLD—Applicanrs Copy <br />