Use of Fleming Park by Mission of Love Church

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CITY OF COLTON PARKS, RECREATION, & FAMILY SERVICES FACILITY USE APPLICATION AND AGREEMENT (909)370-6153 REQUEST FOR'USE OF (DATES) FACILITIES AND EQUIPMENT REQUESTED ❑ Main Room El Tables # ❑ Dance Room ❑ Chairs # ❑ Activity Room ❑ Pool Ll Meeting Room NOTE: PLEASE SUBMIT DIAGRAM g OF SET-UP REQUESTED AT ❑ Kitchen LEAST 48 HOURS PRIOR TO ❑ Game Room SCHEDULED USE. ❑ Baseball Diamond ❑ Field Lights — Time ❑ Snack Bar — Time Fleming Park (Must be approved by Council) Stage SET UP TIME (include set-up / clean-up time) Set up Time: From: J `7 A-wl To: UNIM401 Program Time: From: tJ AAS To: Clean Up Time: From: _ To: 14 36 M Purpose of Activity O Roy—k Expected Attendance: Adults U — ?0 — :._.. Youths + # of Colton Residents A L Is Activity Open to the Public:. Yes No Will Admission Be Charged: Yes No Will Donations Be Accepted: Yes No If yes, what will the proceeds be used for-? DEPT. U E ONLY Received. . rT Initials Date / Tim — Processed ate / Initial Calendar !'(u 4 t Date / Initial We hereby certify that we shall be personally responsible, on behalf of our organization for any damage or unnecessary abuse of buildings, grounds or equipment throughout the use of said premises by our organization. WE AGREE TO ABIDE BY AND ENFORCE THE RULES AND REGULATIONS OF THE CITY OF COLTON AND CERTIFY THAT WE HAVE READ THE RULES AND REGULATIONS ON THE BACK OF THIS APPLICATION. We also received a copy of the Independent Contract Agreement. Yes No Ins. Initials - H. H. A. Will process Ins.Proc. Name of Organization bL:S tot -A CSF LCV5 582 V gt VOO Coal 0 CA Name (please nrint) Signature Contact Pers n @ Event_ Title Address ] ZS F)fT9T P -M _ C -i ac LJE City, Zip Code ffiLTbi,) CA 92-97-4 Phone {daytime) .o9 2-1 15(,_ Phone (evening) Qtq `' Date of application M, Af-Lj4 , 2001 Application For Facility Use Is: Charges Fleming Park: CouncilApproved Denied Deposit Facility Approved Denied Ballfield By Ranilifv Name of Customer Called By Whom Date Approval Is Subject To Conditions Listed On Back Staff Assigned Date Staff Assigned Time Staff Assigned Assigned by (Supervisor) Keys picked up: Staff Member Remarks: Amount Charges I Amount _ VCR/TV Kitchen Cost of Staff I GYM Cost of Lights Insurance PAS stem Other Stage Other Actual Expense (both columns) = Amount Charged to Applicant = Date Paid , 20 Initials Fax Notification: Public Works: Risk (Ins.) Date Date Rcvd Apprvl Inst. Public Works: Risk (Ins.) Date Date Date Proe'd __ , 20 Initials _ PD Fire Elec. Date Date Date Date PD Fire Elec. Date Date Date Date 12/05/00 0"el