Laserfiche WebLink
CITY OF COLTON <br />PARKS, RECREATION, & FAMILY SERVICES <br />FACILITY USE APPLICATION AND AGREEMENT <br />(909)370-6153 <br />PEQUEST FOR USE OF <br />(DATES) OG --I b L c 12. ,a i 1-4 <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Main Room U Tables# <br />❑ Dance Room❑ Chairs # <br />❑ Activity Room ❑ Pool <br />❑ Meeting Room NOTE: PLEASE SUBMIT DIAGRAM <br />g OF SET-UP REQUESTED AT <br />❑ Kitchen 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 />SET UP TIME <br />(include set-up / clean-up time) <br />Set up Time: From: -vv &A To: 3' 30Pr <br />Program Time: From: ic p P A\ To: q'30 P <br />Clean Up Time: From: q '. 3 v P, To: 0: o c, P <br />Purpose of Activity Fvnd Q�vTtnE� l+ie-0 port, <br />Expected Attendance: Adults /p U <br />Youths - -- -�/ 5- <br /># of Colton Residents <br />Is Activity Open to the Public:. Yes __,L"- No <br />Will Admission Be Charged: Yes No <br />Will Donations Be Accepted: Yes ✓ No <br />If yes, what will the proceeds be used fbr? %2 rs r s -1r,: <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 />Staff Member <br />Remarks: <br />DEPT.S .,Qly),Y <br />Received. �1 Ci <br />Initials <br />Date/Time <br />Processed <br />Data / 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 ar 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 THE 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 - H. H A. Will proses InsYmc. <br />Name ofOrganization <br />Name (please print) - Li <br />-Signature <br />Contact Person Qa Event <br />Title 7z�"N /> <br />Address —q/.5 �Q11 n1�G <br />City, Zip Code . / /'OL -(>ti/ <br />Phone (daytime) G%z,;715/ - 9o? <br />Phone(evening)��20> $ <br />Date ofapplication _ . 20�� <br />Date Proc'd , 20 _ Initial$ <br />Fax Notification: Public Works: Risk (Ins:) PD Fire Elec. <br />Date - Data Date Date - Date Date <br />Rcvd Apprvl Inst. Public Works: Risk (Ins.) PD I Fire Elec. <br />Date Date Date Date - Date Date <br />