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CITY OF COLTON <br />NEIGHBORHOOD SERVICE DIVISION <br />FACILITY USE APPLICATION AND AGREEMENT <br />)430-3572 <br />REQUEST FOR USE OF fi lChA C <br />(DATES) <br />FACILITIES AND EQUIPMENT REQUESTED <br />:Main Room ❑ Tables # <br />Dance Room ❑ Chairs # <br />Activity Room ❑ Pool <br />Meeting Room NOTE: PLEASE SUBMIT DIAGRAM <br />Kitchen OF SET-UP REQUESTED AT <br />LEAST 48 HOURS PRIOR TO <br />Game Room SCHEDULED USE. <br />Baseball Diamond <br />❑ Field Lights –Time <br />❑ Snack Bar – Time <br />Fleming Park (Must be approved by Council) <br />❑ Stage <br />TIME OF USE <br />(include set-up / clean-up time) <br />)M SOC- �/✓1 <br />7 Li3lL4 <br />(;// /)/ ioseofActivity f /1�f4 c� <br />acted Attendance: Ac4ts �'7 <br />Youths 000 /- <br />4 of Colton Residents <br />Activity Open to the Public: Yes X No <br />ill Admission Be Charged: Yes No <br />ill Donations Be Accepted: Yes No <br />yes, what will the proceeds be used for? <br />DEPT. I'SE O.N <br />ived. <br />Initials <br />Time <br />vale / initial <br />nate i Initial <br />reby certity that we shall e personally responsible, on <br />of our organization for any damage or unnecessary abuse of <br />igs, grounds or equipment throughout the use of said <br />es by our organization. <br />AGREE TO ABIDE BY AND ENFORCE THE RULES AND <br />]ULATIONS OF THE CITY OF COLTON AND CERTIFY <br />%T WE HAVE READ THE RULES AND REGULATIONS <br />THE BACK OF THIS APPLICATION. <br />also received a copy of the Independent Contract Agreement. <br />No <br />Initials - H. H. A. <br />of Organization _ <br />Person @ <br />Zip Code <br />e (daytime) zf�, 74/ <br />e (evening) �, " <br />of application /� t /, 19 <br />c.. <br />FOR DEPARTMENT USE ONLY <br />Application For Facility Use Is: <br />Fleming Park: Council Approved Denied <br />Facility Approved Denied <br />By <br />Name of Customer Called <br />By Whom Date <br />Approval Is Subject To Conditions Listed On Back <br />Staff Assigned <br />Date Staff Assigned Time Staff Assigned <br />Assigned by (Supervisor) <br />Keys picked up: <br />Remarks:f <br />Charges Amount <br />Charges Amount <br />3e <br />posit <br />Initials <br />Ballfield <br />00 <br />Facility <br />Itc en <br />ost of Staffym <br />Elec. <br />Cost of Lights <br />nsurance <br />7`79,Y—Stem <br />ter <br />tage <br />Other <br />Actual Expense (both columns) _ <br />Amount Charged to Applicant <br />= <br />vaw i aiu <br />Date Proc'd <br />Fax Notification: Public Works: Risk (Ins.) <br />Date Date Date <br />Rcvd Apprvl Inst. Public Works: Risk (Ins.) <br />Date Date Date <br />08/03/99 <br />Facility Use App. <br />19 <br />Initials <br />PD Fire <br />Elec. <br />Date <br />Date Date <br />PD Fire <br />Elec. <br />Date <br />Date Date <br />08/03/99 <br />Facility Use App. <br />