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Application For: <br />City of Colton <br />Community Services Department <br />APPLICATION FOR FACILITY RESERVATION <br />Banauet Hall Meetine Room Athletic Field Anuatics Facilitv ,"' Other <br />Requested Facility(s): rielvtthc k7avlc <br />Requested Date(s) (Day/Date): a- 12-06 <br />CST ) <br />Set -Up Time: io.r,,, to VZ! 30 P,.,.r <br />Program Time: <br />I pyrt to 5� , ,Clean <br />-Up Time:5,,Jo 6Pm <br />Group/Organization: CprirovA, — ennple APo5••6ito Gtiv-" <br />Contact Person: • Ge Nvnez- <br />Alternate Contact Person: BaA%e Cc vy pa <br />Address: Mpg +o, �k It Dui, <br />Address: 5:50 Vic, Lct}ae -4 10 <br />City & Zip Code: C�l�c, ciq 8237-4 <br />City & Zip Code Cot.}rti,, ce g232q <br />Home Phone: �c )2gl-LIIOS <br />Work Phone: 3 ZgIO <br />Home Phone- dd <br />Work Phone: �zo ss <br />Estimated Total Event Attendance: 200'130?dults Y00:1c eons ° - jOZhildren <br />Reason for Use: StnolspercY�+�r� (Concert) <br />EquipmentlService Requested: 4 # of Tables Athletic Lights <br />(subject to availability) IOU # of Chairs times: from: pm <br />Kitchen/Concessions to: pm <br />Additional Request(s): (.-=AAe_ - <br />RENTAL AGREEMENT <br />I/We hereby certify that we shall be personally responsible, on behalf of our group/organization, for any damage or abuse of buildings, grounds, <br />fields, equipment, or other facilities through the use of said premises by our group/organization. I/We agree to abide by and enforce the rules <br />and regulations of the City of Coulton andel certify that w� a have read the rules and regulations listed on the back of this application. <br />Signature of Applicant: uP�! Y 1 Date: <br />(For Office Use Only) <br />1194 MANNO1V1L1-14:1 <br />Security Required <br />Insurance Required <br />Copies <br />Facility Notified/Date <br />Payment Due Date <br />Reservation Fee <br />Cleaning Deposit <br />Date Applicant Notified <br />Receipt Number <br />Staff Initials/Date <br />White - Office • Canary - Facility • Green - Maintenance Pink - Patron <br />