1999 AGN JUN 01 I06 - Laserfiche WebLink

Browse Search

CITY OF COLTON NEIGHBORHOOD SERVICE DIVISION FACILITY USE APPLICATION AND AGREEMENT (909) 370-6153 REQUEST FOR USE OF FIPMtnQ TqQ{K (DATES) + 199 FACILITIES AND EQUIPMENT REQUESTED ❑ Main Room ❑ Tables # O Dance Room ❑ Chairs # ❑ Activity Room ❑ Pool O MeetingRoom NOTE: PLEASE SUBMIT DIAGRAM OF SET-UP REQUESTED AT ❑ Kitchen LEAST 48 HOURS PRIOR TO O Game Room SCHEDULED USE. ❑ Baseball Diamond O Field Lights — Time ❑ Snack Bar — Time }� Flepiing Park (Must be approved by Council) Stage TIME OF USE (include set-up / clean-up time) FROM A • Pin fl -M. TO Purpose of Activity n {D4 t^i rn Expected Attendance: Adults Youths 15 # of Colton Residents Is Activity Open to the Public: Yes _ No Will Admission Be Charged: Yes _ No Will Donations Be Accepted: Yes No If yes, what will the proceeds be used for?_ DEPT. USE ONLY Received. Initials Date / Time Processed Date / Initial Calendar Date / Initial 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 throughout 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. We also received a copy of the Independent Contract Agreement. Yes No Ins. Initials - H. H. A. Will process 1M.Pra. Name of Organization e';4. _ a CA I+nn Name (please print) Signature M" Contact Person @ E \ �l Title AX Address Logo City, Zip Code I Phone (daytime) _ Phone (evening) r Date of application FOR DEPARTMENT USE ONLY Application For Facility Use Is: 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 A;signed by (Supervisor) Keys picked up: Stiff Member Remarks: 20f 19 '71 Date Proc'd , 19 _ Initials Fax Notification: Public Works: Risk (Ins.) PD Fire Elec. Due Date Date Dare Dau Date Rcvd Apprvi Inst. Public Works: Risk (Ins.) PD Fire Elec. Oati Date Dau tau Dau Dae 12AIM Facility Use App.