Laserfiche WebLink
%-11 r yr UULTON <br />NEIGHBORHOOD SERVICE DIVISION <br />FACILITY USE APPLICATION AND AGREEMENT <br />j`IG (909)430.357? <br />REQUEST FOR USE OF r Il rn <br />(DATES) (C, <br />Main Room <br />LI Tables is I) <br />Dance Room <br />O Chairs #� <br />.activity Room <br />p Pool <br />Meeting Room NOTE: <br />PLEASE SUBMIT DIAGRAM <br />Kitchen <br />OF SET-UP REQUESTED AT <br />Game Room <br />LEAST 48 HOURS PRIOR TO <br />Baseball Diamond <br />SCHEDULED USE. <br />O Field Lights —Time <br />er <br />CI Snack Bar —Time <br />_ <br />I Fleming Park (Must be approved by Council) <br />C3 Stage <br />TIME OF USE <br />include se -u /clean-up time) <br />ROM <br />O Z <br />urpose of Activity <br />xpected Attendance: Adults <br />Youths <br />—15 <br /># of Colton Residents <br />_'I'S 'IQ <br />Activity Open to the Public: <br />Yes k No <br />'ill Admission Be Charged: <br />Yes No <br />'ill Donations Be Accepted: <br />Yes No )C <br />Yes, what will the proceeds be used for? <br />annual <br />�r <br />Application For F11'cility Use Is: <br />riemurg Parka 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 <br />j�up: <br />� � (� j�� �t�t� <br />D �pn/ ;D(PR'emarks: 201L`-Li,��i ` rX.T berG1 YUy i�5 <br />yll� l <br />I ill 5 <br />Time r� % <br />Date. Initial <br />Date : Initial <br />ereby certify t at we b"411 e personally responsible. on <br />f of our organization for any damage or unnecessary abuse c r <br />ngs, grounds or equipment throughout the use of said <br />ses by our organization. <br />✓E AGREE TO ABIDE BY AND ENFORCE THE RULES AND <br />EGULATIONS OF THE CITY OF COLTON AND CERTIFI <br />HAT WE HAVE READ THE RULES AND REGULATIONS <br />N THE BACK OF THIS APPLICATION. <br />(e also received a copy of the Independent Contract Agreement. <br />es No <br />Initials - H_ H WII p s ins Pro. <br />of Organization y F ,tp F} Ft(pK� <br />to (please print) P2f.A(nL, <br />lature <br />tact Person @ Event�e. �iYLR.I �7 Y(t 1 Y3 t Q� <br />fi Cym(nal <br />rens+aoll/�Leferat�'�l� t <br />, Zip Code W Ltno CR <br />to (daytime) Sf tIC�. TJ— 71 3�J111� <br />to (evening) bZL <br />of application ` 19 (aq <br />USE ONLY <br />Amount <br />Charges Amount <br />o0 <br />n <br />Na6ity <br />ym <br />nstr <br />ter <br />er <br />Actual Expense (both columns) <br />_ <br />Amount Charged to Applicant <br />= <br />r, Initials <br />DateProc'd ,19_ Initials <br />Fax Notification: Date Public Works: Risk (Ins.) PD. <br />Dace Date Date Date Date <br />Fire Elec. <br />Rcvd Apprvl Inst. Public Works: Risk (Ins.) PD Fire Elec. <br />D(ate� ' /'� Date Date Date Date Date 08 03 c4q <br />�' "a I (q y IM �i{C+. _ J Faedmv usc.%pp <br />, <br />�ell�CA(*- Rul`,J,.-A RPed, I (n:r\ �o����q tih f rmv <br />