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CITY OF COLTON <br />HUMAN SERVICES DEPARTMENT <br />APPLICATION AND AGREEMENT FOR FACILITY USE <br />REQUEST FOR USE OF <br />„-' cr Fa (Grd� 0) ark <br />ON (DATES) C e P f'cl 1L <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Multi -Use Room ❑ Banquet Tables # <br />❑ <br />Activity Room <br />❑ <br />Community Room <br />❑ <br />Kitchen <br />❑ <br />Baseball Diamond <br />❑ <br />Pool <br />❑ Chars # <br />❑ P.A. System <br />3 Other 12a��ase., s <br />TIME OF USE <br />FROM O O AM, P.M <br />TO 16: O O <br />Qr9src�is 1'06 -'Coo Pw SA "P- lcksmuo I lR <br />t. Purpose of Activity: �rv2TI Sc,,,.r.ar <br />IOU iii (C- <br />2. Expected Attendance: Adults dna_ <br />Youths <br />3. Is Activity Open to the Public: <br />Yes X No <br />4. Will Admission Be Charged: <br />Yes No <br />5. Will Donations Be Accepted: <br />Yes No <br />If yes, what will the proceeds be used for? <br />/�7 <br />CAwiCL.� o T:CQ 'Cb 110-11 L H nNc{faKt:Js <br />We hereby certify that we shall be personally responsible, on <br />behalf of our organization for any damage or unnecessary <br />abuse of buildings, grounds or equipment through the use <br />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 BACK <br />OF THIS APPLICATION. <br />Name of Organization Fri e. Q( of l!-. 1 �. C•.4y�I <br />Name (please print) �^Ay Mme✓ <br />Signature - <br />Title /►'IAver - <br />Address y l ilnAt' A f <br />City, Zip Codei-- <br />Phone (daytim5) 3S 7 - S i i1D xr 2S's <br />Date 9 I .19 <br />�t'JSr6.w� ri OT C00% ,,fy <br />2ticPt.�.scs ���'( /OY <br />S <br />OIGf, (wL,l. 4 ivy ttCa o(- t;icf�u���l> <br />Ivo It C a ,•- �.tr-c.-�' c.0 v � T�L C-r.....rp.c. � e �npn l �7`r� <br />CiG C-t✓� � 7 _ S�lrt✓SO�tX /��, '� ('ic..TRr'�aw. I�. <br />r <br />IIl,it�lr Sa,..Q. Yowl lt.S�cs c:. -..P Polr�<(�.^iLc C� <br />-.;- <br />FOR DEPARTMENT USE ONLY <br />Application For Facility Use Is: Remarks <br />Approved Denied <br />By <br />Approval Is Subject To Conditions Listed On Back <br />Deposit <br />Fee <br />Wme - Office <br />Yellow • Pamid" <br />Pink • Facility <br />Goldenrod • Pubiie Works <br />Date Paid ,19 <br />Date Processed ,19 <br />