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O 0 REQU 'FORT CITY OF COLTON NEIGHBORHOOD SERVICE DIVISION N w FACILITY USE APPLICATION AND AGREEMENT (909) 370-6153 eOF FACILIT>(ES AND EQUIPMENT REQUESTED Main Room ❑ Tables # Dance Room ❑ Chairs # Activity Room ❑ Pool Meeting Room NOTE: PLEASE SUBMIT DIAGRAM g OF SET-UP REQUESTED AT Kitchen LEAST 48 HOURS PRIOR TO Game Room SCHEDULED USE. Baseball Diamond ❑ Field Lights — Tune �FSnack Bar — Time _ let3''uug Park (Must be approved by Council) fY Stage TMK OF USE (include set-up / clean-up time) :OM 19. -Cb &M, a ab #M.. wpose of Activity o.+etl� a"' 8w :pected Attendance: Adults .'( Youths ? # of Colton Residents Activity Open to the Public: Yes No ill Admission Be Cw Yes No ill Donations Be Accepted: Yes No yes, what will t proceeds be used for 9 (�n P,oI *41 ,04 1" DEPT. USE ONLY ived. Initials / Tune ,ssed Date / Initial �- I 1 g co r alendar Date /:Initial Fleming Park: Council Approved Denied Facility Approved Denied By Name of Customer Called By Whom Date Approval Is Subject To Conditions Listed On Back Staff Assigned Date Staff Assigned __ Time Staff Assigned Assigned by (Supervisor) Keys picked up: Staff Member Remarks:2),h e� 1�e oml+ &,4V &t t Ve hereby certify that we shall be personally responsible, on 1 f our organization for any damage or unnecessary abuse of uildings, grounds or equipment throughout the use of said remises by our organization. 'E AGREE TO ABIDE BY AND ENFORCE TIE RULES AND EGULATIONS OF THE CITY OF COLTON AND CERTIFY HAT WE HAVE READ THE RULES AND REGULATIONS N THE BACK OF THIS APPLICATION. le also received a copy of the Independent Contract Agreement. es - . — NA - H H. A. Zip Code U U-8 n & a'l e (daytime) ClO q 370-15053 e (evening) of application 13— Z I , 19 Cha es Amount Charges Amount Deposit VCR / TV Ballfield Pool Facility Kitchen Cost of Staff Gym Cost of Lights Insurance PA System Other Stage Other Actual Expense(both columns = Amount Charged to Applicant = llate ma , 19 Initials Date Proc'd , 19 Initials Fax Notification: _ Public Works: Risk (Ins.) Date Date Rcvd Apprvi Inst. Public Works: Risk (Ins.) Date Date 11 Date Date PD Fire Date PD Fire Date Elec. Date Date _ Elec. Date Date