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t-eu eu ij ugsgap Brigid Inampson 6512515494 p.3 <br /> Facility Use Applicotion/Centennial kboel District ' y a I <br /> (This form does NOT apply to the Perforna>ag Arm Cents Of Middk School Auditorium) <br /> ia Centers'al Comnwniry Service's 4707 Notch Road, Circle Pines, MN 55014 <br /> 763.792 -6100 FAX 763.792 -6113 <br /> eaoo" swan to <br /> CotapieW and I MM form at least two weeks in advance. This application does trot gttttrantee a reservation. <br /> When confirmed, a building use permit and invoice will be amt Pay pnxWly and bring Permit with you when you use facility. <br /> Requested Fmhty U Yl �'L l i7'(i..it �t !!� h • t� � '-+� S ,'��, <br /> School Name (Use a apwete Corm ror each school ) nm <br /> ` Mueoding <br /> Day (circle): Sun M T W Th F Sat'? Dates: (0, (G a = I <br /> Time: Date -/G / j Date <br /> Arrival at Facility 30 AM PM AM - Nate Your train` ^st to ore► nerd ibe building <br /> PM vacated by scheduled &pwUne ore and the W. <br /> ittry,mat be left in good eatdsuon or you nuy be <br /> Activity Begins AM PM _ ^Alec _ ch "'Ind e ovcm=. haft facility use <br /> Activity Enda AM ,�_PM 're Leo front a rrivei in faerlioy so departure <br /> AM PM or why. <br /> DWAr. Facility A.M1 PM AM PM - <br /> Activity: Youth ' • �'Adti�t ,� Describe Activity (Please be specific): �J �(,r (� (all <br /> i D S 13 <br /> Food: Ns Yes (Group,mim comply with Anoka County Food Code.) <br /> Equipment or set -up Deeds (All coupe are squired to do bode set -up end dean up with do Inletattoe or site sepeavicon or cule"I NO <br /> C <br /> Snowplowing, aervica: Yee (additional agnpMent wi ll be forwarded.) <br /> Name of group: %A 11, . 'E� 116 <br /> Contact person , l CY(D I�c,, I m /I i <br /> Phone (include area code): Day Eveai>�_ <br /> j f ALL CENTENNL ,L <br /> Address / ��/ (iJ�`l 1 kC 91 Fax GROUNDS ARE <br /> clty/StaterzIP l� 1 h 't � , ?t a s S t I TOBACCO FREE. <br /> 'knnisl Schale are cloned due to faclell"t weetker, Power oarelee a odw buiidire mmlwgis. st) facisiry►aervatt on cvnraete sue sarrceMod. <br /> School 'Ali whcn Cen ool pa nited acu rodiea superv ( <br /> u U or older)for all bu r i we n o t Jo a4en'ro► mss be in iM IlW16 l wit, the boar N all limp. <br /> ool I (ores rperriae dre 5saltry, b re n o t b <br /> 'School divrin fuirities win open ONLY when ft S&h eceiviq aupcavgtp of the Permit- iroYpsl youp � or do ecsivitiq. <br /> 'coups ,snot provide t,eh own cquiptostt for dm use. Physieat a)treetien egriPntera u not evailabk. taw an site. <br /> ' ( A'ras) OyahS ey) W will {foes priority in thir fteeMrt. <br /> Sprint (APtri•Meyl Sturartet Fill ors • eepanle loan for ON* **eon: Fan (Sept. -occ -1 Wink, (tan- March). <br /> 'Soccer balk. baabalb sad sdtbalb aw nos perrrj%W Sots pr nef t)" bane tare allowed. No ood allowed in !e Inn <br /> •Plesee read yow pu41 b e sent if a afNC is aaisairla r aogaenet. slit an unareitebte dare sa elelea liaed on pewit an confI <br /> Pt med dwa. <br /> tntir and invoice wi0 s sang N eerttett Person stye prpeseiaa <br /> Canned S n. adNW a a ehealn b a Writ mist of eomc * Ce lmisl Coartaraity Services. A ruin imam of '** days: notice is regarrtd. <br /> pa q ehulei way be,ceased ro say pgtp rf notice of cwtcctletion rs Dot Mceived befbre this tone. <br /> PaymrwI for 6eUity vac mu»!e fade in fir , alit p f arcility een be dMied if <br /> Mmtnna bur A two(I),ow nrifth err Mymat a a. teteired. <br /> nay be segahed. esPeegay ap aweloends. <br /> Sign ature Date <br /> Approve OFFICE USE ONLY <br /> Site S ' �� <br /> upervisor: Billable __i. Permit# R ► �- <br /> Claus: Al A2 <br /> A3 B )C1 C2 C3 <br /> 911 <br />