1998 AGN MAY 05 I13 - Laserfiche WebLink

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REQUEST FOR USE OF (DATES) CITY OF COLTON NEIGHBORHOOD SERVICES DEPARTMENT FACILITY USE APPLICATION AND AGREEMENT 370-6153 FACILITIES AND EQUIPMENT REQUESTED ❑ Main Room ❑ Dance Room ❑ Activity Room ❑ Meeting Room ❑ Kitchen ❑ Game Room ❑ Baseball Diamond ❑ Tables # ❑ Chairs # ❑ Pool ❑ Field Lights - Time ❑ Snack Bar - Time PLEASE SUBMIT DIAGRAM OF SET-UP REOUESTED AT LEAST 48 HOURS PRIOR TO SCHEDULED USE. s "/� TIME OF USE �*� FROM _ l�D� ( A. PM . TO ] Purpose of Activity: Q 2. Expected AVendance: Adults Ivo Youths 3. Is Activity Open to the P Yes No 4. Will Admission Be Charged: Yes No 5. Will Donations Be Acc ed: Yes L. No If y s, what will the proceeds be used for? Application For Facility Use Is: Approved Denied By 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 through 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. Name . Organization .I V7 i .iii '_. . Name'(please print) Z Signature Tine Address City, Zip Code L/ Phone (daytime)C Phone(evening) Date of application ,19 FOR DEPARTMENT USE ONLY Approval Is Subject To Conditions Listed On Back Deposit Remarks Fee Date Paid Staff Assigned_ Date Staff Assigned Assigned by (Supervisor) Time Staff Assigned Date Processed Keys picked up: tatf Member White - Office • Canary - Permittee • Pink - Facility • Goldenrod - Public Works ,19 ,19 5197