Laserfiche WebLink
REQUEST FOR USE OF <br />our a ONM FORM W11) 711114M <br />CITY OF COLTQN <br />NEIGHBORHOOD SERVICES DEPARTMENT <br />FACILITY USE APPLICATION AND AGREEMEN <br />?0-&153 ECEP <br />(DATES) -,91 tg o —e z <br />Q <br />Main Room <br />Q <br />Dance Room <br />L) <br />Activity Room <br />1. Purpose of Act'' <br />Meeting Room <br />Q <br />Kitchen <br />U <br />Garbs Room <br />EGLUPMENT REQUESTED <br />• Tables e <br />• Chairs # <br />E3 Pool <br />PLEASE SUBMIT DIAGRAM <br />OF SET-UP REQUESTED AT <br />LEAST 48 HOURS PRIOR <br />TO SCHEDULED USE. <br />U Baseball Diamond <br />p - Field Lights, - Time <br />D - Snack Bar - Time <br />TIME OF USE <br />FROM �,6 ► +ci Cj <br />P.M. <br />TO 9:0o- <br />1. Purpose of Act'' <br />r r <br />2. Expected Attendance Adults —�d U <br />Youths <br />3. is ActivRy Open to the Public: <br />No <br />4. will Admission So Charged: <br />Yes <br />b. Will Donations Be Accepters: <br />No <br />yes, wh wilt he proceeds <br />Ice # <br />A i a `v f <br />e <br />We hereby certify that we shall be personally responsible, <br />on behalf of our organization for any damage or <br />unnecessary abuse of buildings, grounds or equipment <br />through the use of said premises by our organization. <br />WE AGREE TO ABIDE BY AND ENFORCE THE RULES AND <br />REGULATIONS OF THE CITY OF COLTON AND CERTIFY THAT <br />VILE HAVE READ THE RULES AND REGULATIONS ON THE <br />BACK OF THIS APPLICATION. o0me 3 fa _ 2 Q <br />�.; Ta <br />Name of Organization ��u� S64 Dj <br />M <br />Signature <br />Tide -7; <br />Addressv <br />City, Zip Code 2 <br />Phone (daytime) 1d - 4r 0 4 S"' <br />Phone(evening) 1 d <br />Date of application 17— 7 <br />FOR DEPARTMENT USE ONLY <br />Application For Facility Use Is: <br />Approved Denied <br />Approval Is Subject TO Conditions Listed On Back <br />Deposit <br />Fee <br />Staff Assigned <br />Remarks <br />Date Paid , 19 <br />r._._ o.______1 <br />