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F <br />REQUEST FOR USE OF <br />ON (DATES) <br />CITY OF COLTON <br />HUMAN SERVICES DEPARTMENT <br />APPLICATION AND AGREEMENT FOR FACILITY USE <br />UQ1 a32°, lgqu - <br />FACILITIES AND EQUIPMENT REQUESTED <br />❑ Multi -Use Room ❑ Banquet Tables # <br />D Activity Room <br />❑ Community Room <br />❑ Kitchen <br />❑ Baseball Diamond <br />❑ Pool <br />❑ Chairs # <br />❑ P.A. System <br />❑ Other <br />TIME OF USE <br />FROM 5', M A.M., P.M. <br />TO I0'. W A.M., <br />1. Purpose of Activity: _ C1AkA9_ ," fnEE l V f > <br />2. Expected Attendance: Adults 100 <br />Youth 100 <br />3. Is Activity Open to the Public: <br />( Yes J No <br />4. Will Admission Be Charged:: <br />Yes No l <br />5. Will Donations Be Accepted: <br />es)No <br />If yes, what will the proceeds be used for? <br />U-ku� <br />Application For Facility Use Is: <br />Approved Denied <br />BY <br />Facility/Ti/Field rk <br />(Circle One) <br />We hereby certify that we shall be personally responsible, on <br />behalf 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 RULES AND REGULATIONS ON <br />THE BACK OF THIS APPLICATION. Q <br />Name of Organization tuy xoyJ -FAST ? tST <br />QAA ue <br />Nam rint) Rlnm <br />Signa - <br />Title MM'�kG <br />Address 19 QST F. GT <br />City, Zip Code._Cco-X0VJ , a37 <br />Phone (daytime) Is 4P90 <br />Date 2 o�7-'19 cep_ <br />FOR DEPARTMENT USE ONLY <br />Approval Is Subject To Conditions Listed On Back <br />Deposit <br />White - Office <br />Yellow - Permittee <br />Pink - Facility <br />Goldenrod - Public Works <br />Remarks <br />Date Paid 19__ <br />Date Processed '19 <br />