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CITY OF COLTON NEIGHBORHOOD SERVICE DIVISION FACILITY USE APPLICATION AND AGREEMENT r•— 30-3572 909)4 REQUEST FOR USE OF r I� (DATES) FACILITIES AND EQUIPMENT REQUESTED Main Room ❑ Tables # Dance Room ❑ Chairs # Activity Room ❑ Pool Meeting Room NOTE: PLEASE SUBMIT DIAGRAM OF SET-UP REQUESTED AT Kitchen LEAST 48 HOURS PRIOR TO Game Room SCHEDULED USE. Baseball Diamond ❑ Field Lights -Time ❑ Snack Bar - Time Fleming Park (Must be approved by Council) ❑ Stage -- TIME OF USE (include set-up / clean -u time) M IZ.(xj Na©� irpose of Activity Ca'W (:AN(L)liXVICIV17l'Clebr :pected Attendance: Adults Youths 300 # of Colton Residents I OQ 01 Q Activity Open to the Public: Yes -Y,- No I Admission Be Charged: Yes No I Donations Be Accepted: Yes No is :s, what will the proceeds be used for? DEPT. LSE ONLY ived. Initials Time :ssed Date / Initial idar Date / Initial -ey cern t at we s a e persona y response e, on of our organization for any damage or unnecessary abuse of gs, grounds or equipment throughout the use of said es by our organization. AGREE TO ABIDE BY AND ENFORCE THE RULES AND 3ULATIONS OF THE CITY OF COLTON AND CERTIFY kT WE HAVE READ THE RULES AND REGULATIONS THE BACK OF THIS APPLICATION. also received a copy of the Independent Contract Agreement. A No Initials - K H. of Organization Person (a). Event Zip Code Co Lhn . C I - ct- jz,4 e (daytime) OA) 370 ` tel 59 e (evening) p,, of application Nln(- 13 tv 2600 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 _ Assigned by (Supervisor) Keys picked up: Staff Member Charges Amount Charges Amount eposn Initials a Ieoo Date Proc'd acl [F'i ty nc en Cost of Staff(Ty M_ ost o [g Its nsurance PA System ter tage er Actual Expense (both columns) = Amount Charged to Applicant = Remarks: Date rata 19 _ Initials Date Proc'd , 19 Initials Fax Notification: Public Works: Risk (Ins.) PD Fire Elec. Date Date Date Date Date Date Rcvd Apprvl Inst. Public Works: Risk (Ins.) PD Fire Elec. Date Date Date Date Date Date 08/03/99 Facility Use App.