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REQUEST FOR USE OF <br />ON (DATES) <br />CITY OF COLTON <br />HUMAN SERVICES DEPARTMENT <br />APPLICATION AND AGREEMENT FOR FACILITY USE <br />Fleming Park <br />December 8,1990 <br />FACILITIES AND EQUIPMENT REQUESTED <br />O Multi -Use Room ff Banquet Tables N 3 <br />O Activity Room :2 Chairs M --A-- <br />* Community Room ❑ P.A. System <br />O Kitchen O Other <br />O Baseball Diamond <br />❑ Pool <br />TIME OF USE <br />FROM nine (A M), P.M. <br />TO 1 A.M.( OM) <br />1. Purpose of Activity: Christmas' program <br />2. Expected Attendance: Adults 200 <br />Youth 200 <br />3. Is Activity Open to the Public: <br />Yes XX No <br />4. Will Admission Be Charged: <br />Yes No XX <br />5. Will Donations Be Accepted: <br />Yes No. XX <br />If yes, what will the proceeds be used for? <br />Application For Facility Use Is: <br />Approved Denied <br />BY <br />Facility/Pool/Field/Park <br />(Circle One) <br />We hereby certify that we shall be personally responsible, on <br />behaN of our organization for any damage or unnecessary <br />abuse of buildings, grounds or equipment through the use <br />of said premises by our organization. <br />WE AGREE TO ABIDE BY AND ENFORCE THE RULES AND <br />REGULATIONS OF THE CITY OF COLTON AND CERTIFY <br />THAT WE HAVE READ THE RULED AND REGULATIONS <br />ON THE BACK OF THIS APPLICATION. <br />Name of Organization Chamber of Commerce <br />Name (PI a print) _Pam Gregory <br />Signature — <br />Title Administrative Asistant <br />Adress A7n m- T n f adena Dr_ <br />City, Zip Code Colton, CA 92324 <br />Phone (daytime) 875-51979 <br />Date _ November 2 —.19 90 <br />FOR DEPARTMENT USE ONLY <br />Approval Is Subject To Conditions Listed On Back <br />Deposit <br />Fee <br />White - Office <br />Yellow - Permittee <br />Pink - Facility <br />Remarks <br />Date Paid 19 <br />