Laserfiche WebLink
CITY OF COLTON <br />PARKS, RECREATION, & FAMILY SERVICES <br />FACILITY USE APPLICATION AND AGREEMENT <br />9) 3 0-6153 <br />USE OF <br />BEQUEST FOR tv2 <br />(DATES) O <br />1 /liQrt n d rA lOa <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Main Room ❑ Tables # <br />❑ Dance Room ❑ Chairs # <br />C3Activity Room ❑ Pool <br />ROTE: PLEASE SUBMIT DIAGRAM <br />O Meeting Room OF SET-UP REQUESTED AT <br />❑ Kitchen LEAST 48 HOURS PRIOR TO <br />❑ Game Room SCHEDULED USE. <br />❑ Baseball Diamond <br />❑ Field Lights — Time <br />❑ Snack B ar — Time <br />❑ Fleming Park (Must be approved by Council) <br />❑ Stage <br />SET UP TIME <br />(include set-up / clean-up time), OL) <br />up Time: From: 'ZOO To: <br />Program Time: From: <br />To • �D <br />Clean Up Time: Fr m: 1l% ' CO To: —p_ <br />n <br />Purpose of Activity <br />Expected Attendance: Adults <br />Youths ;�p 0 <br /># of Colton Residents <br />Is Activity Open to the Public:. Yes \ No <br />Will Admission Be Charged: Yes No X <br />Will Donations Be Accepted: Yes No iC <br />If yes, what will the proceeds be used for? <br />DEPT - USA ONLY <br />Received. <br />itials <br />Date/ Time _Z <br />Processed <br />Date / Initial <br />Calendar 2"— , '.'er <br />Date— <br />Date Ini ' <br />We hereby certify that we shall be personally responsible, on <br />behalf of our organization for any damage or unnecessary abuse <br />of buildings, grounds or equipment throughout the use of said <br />premises by our organization. <br />WE AGREE TO ABIDE BY AND ENFORCE THE RULES <br />AND REGULATIONS OF THE CITY OF COLTON AND <br />CERTIFY THAT WE HAVE READ THE RULES AND <br />REGULATIONS ON THE BACK OF THIS APPLICATION.. <br />We also received a copy of the Independent Contract <br />Agreement. Yes No <br />Ins. <br />Initials - K H. A. W' 1 pr9cwsInp.Pmc. <br />Name of Orgaization C*A U =1 <br />,M:�_ <br />Name (please -print) (Ileeq It & <br />Signature l 'k <br />Contact Person Q Event <br />Title IQe Cf -&a ftp_ <br />Address LP /U L'd UZ <br />City, Zip Code . <br />Phone (daytime <br />Phone (evening) <br />Date of applieatio%l 20 <br />Application For Facility Use Is: <br />Charges Amount <br />Charges Amount <br />FlemliIgPark. Council Approved Denied <br />Deposit <br />VCR / TV <br />Facility Approved Denied <br />Ballfield <br />Pool <br />By - <br />Facility <br />Kitchen <br />Name of Customer Called <br />Cost of Staff <br />By Whom Date <br />Cost of Lights <br />Approval Is Subject To Conditions Listed On Back <br />pA S stem <br />!Insurance <br />r <br />Staff AssignedDate <br />S e. <br />r <br />Staff Assigned Time Staff Assigned <br />Assigned by (Supervisor) <br />Actual Expense (both columns) <br />= <br />Keys picked up: <br />Amount Charged to Applicant <br />= <br />Staff Member <br />Date Paid , 20 <br />Initials <br />Remarks: <br />Date Proc'd , 20 Initials <br />Fax Notification: Public Works: Risk (Ins.) PD Fire Elec. <br />Date Data Date Date Date Date <br />Rcvd Apprvl Inst. Public Works: Risk (Ins.) PD Fire Elec. <br />Date Date Date Date nAr, nor. <br />