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REQUEST FOR USE OF <br />(DATES) <br />gran OMNEss Aorw COM M4)4n <br />CITY OF COLTON <br />NEIGHBORHOOD SERVICES DEPARTMENT <br />FACILITY USE APPLICATION AND AGREEMENT <br />370-6153 <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Main Room ❑ Tables K <br />❑ Dance Room ❑ Chairs M <br />❑ Activity Room 0 Pool <br />❑ Meeting Room PLEASE SUBMIT DIAGRAM <br />❑ Kitchen OF SET-UP REQUESTED AT <br />LEAST 48 HOURS PRIOR <br />❑ Game Room TO SCHEDULED USE. <br />❑ Baseball Diamond <br />(3 - Field Lights - Time <br />❑ - Snack Bar - Time <br />E OF USE <br />FROM <br />TO A M. P.M. <br />1. Purpose of Activi <br />2. Expected Attendance: Adults �' <br />Youths_ <br />3. IssAActivity Open to the Public: <br />/Yes ) No <br />4. Will Admission Be Charged: <br />Yes No <br />5. Will Donations Be Accepted - <br />yes �N <br />If yes, what will the proceeds be used for? <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 />WE HAVE READ THE RULES AND REGULATIONS ON THE <br />BACK OF THIS APPLICATION. <br />Of <br />Name (oleaa6 brint) U M . A r- n., a 11 N , <br />Signature ----r' �—� <br />Title <br />Address <br />City, Zip code C Ll$,sr-, QL2.5 <br />Phone (daytime) <br />Phone(evening) <br />Date of application ,19 <br />FOR DEPARTMENT USE ONLY <br />Application For Facility Use Is: <br />Approved Denied <br />Di <br />Approval Is Subject To Conditions Listed On Back <br />Deposit <br />Fee <br />Staff Assigned <br />Date Staff Assigned Time Staff Assigned <br />Remarks -- <br />Date Paid , 18 <br />Date Processed '19 <br />