Laserfiche WebLink
psQUEST FOR USE( <br />(DATES) <br />CITY OF COLTON <br />PARKS, RECREATION, & FAMILY SERVICES <br />FACILITY USE APPLICATION AND AGREEMENT <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Main Room ❑ Tables# <br />❑ Dance Room ❑ Chairs # <br />C3 Pool <br />❑ Activity Room <br />❑ Meeting Room NOTE: PLEAS- SUREQ STEED AT <br />. OF SET-UP REQUESTED AT <br />❑ Kitchen LEASr 48 HOURS PRIOR TO <br />❑ Game Room SCHEDULED USE. <br />• BaseballDiamond <br />❑ Field Lights - Time <br />❑ Snack Bar -Time <br />❑ Fleming Park (Must be approved by Council) <br />❑ Stage <br />SET UP TIME <br />(include set-up / clean-up time) <br />Set up Time: From: S: Le To: 10:0D YNR <br />Program Time: From: 10: LV fi'M To: 1 00 , .1 <br />Clean Up Time: : 1 QUTo: t,00 -1. <br />PurposeofActivity ti, U �(I <br />Expected Attendance: Adults Zt'1 +' <br />Youths 100 i <br /># of Colton Residents <br />Is Activity Open to the Public:. Yes X No _ <br />Will Admission Be Charged: Yes No <br />Will Donations Be Accepted: Yes No X <br />If yes, what will the proceeds be used for? <br />F OX PAI <br />Application For Facility Use Is: <br />Remingpark CouncilApproved 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 />StaffAssigned <br />Date Staff Assigned Time Staff Assigned <br />Assigned by (Supervisor) <br />Keys picked up: ' <br />Staff Member <br />Remarks: <br />DEPT. NLYhj <br />Received. <br />Initials <br />Date / Time <br />Processed <br />Date / Initial <br />Calendar <br />Date / Initial <br />We hereby certify that we shall be personally responsible, on <br />behalf of our organization for any damage or unnecessary abuse <br />of buildings, grounds or equipment throughout the use of said <br />premises by our organization. <br />WE AGREE TO ABIDE BY AND ENFORCE THE RULES <br />AND REGULATIONS OF THB CITY OF COLTON AND <br />CERTIFY THAT WE HAVE READ THE RULES AND <br />REGULATIONS ON THE BACK OF THIS APPLICATION.. <br />We also received a copy of the Independent.Contract <br />Agreement. Yes No <br />Ins. <br />Initials - K K W'11 pmpen Ine.Pmc. C <br />Name of Organization del� <br />Vt#'Z91'6 Di FDI?-,(Ao CP'17S <br />Name (please print) 64rl <br />Signature <br />Contact Person @ Event MrI 4tltGtl1& <br />Title <br />Address 1401 �Iy <br />f. 11'i% kAJ <br />City, Zip Code CO I, -h A CW Ct?,324 <br />Phone (daytime),`''_'. �`_,�,,,�, i 0 � <br />Phone (evening) ICS ?Tait A k'br&u 4.09- e <br />Date of application �A— ' 20 Q_ <br />Date Proc' d , 20 _ Initials <br />Fax Notification: Public Works: Risk (Ins.) PD Fire Elec. <br />Dat Date Data Dat Date Date <br />Rcvd Apprvl Inst. Public Works: Risk (Ins.) PD Fire Else. <br />Date Data Dat Date Dat Dat <br />