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.~ <br />~....., <br />n=L?~s ~~~ ~~••^_•_L?riAY';?I ANU Pz•Lrrtts Dr~ART~lE~Ti' <br />71PPLZCATIG`1 PJR USr, l7y C„LITIT;N ~`~r'J~JR GRGL:3DS <br />REQUEST FCR LISw OF <br />(FACILITY/IKEA) (PORTId~i Or AREA/FACILI`S"C) <br />P~'QU'Si~D BY: <br />t•L~ILI:IG ACbitS.SS : TELEPHO~T <br />A~Tc.,r, REQITF.5L~?: b:C~I'I:I DAY XEAR HOURS <br />PURPOSE FD2 4,iiICH ?.c,0~7~..ST IS t•!~Ds: <br />TYPE PROGRAt•I TO B GI's <br />T CartiPy that I am authorized to act t:or the above-named organizatipn and <br />that said arganizatxoa will be responsible foz any and all damages done to the <br />p1aYt ar ec;u.ip~ent wh.,1e b=ing used by said, organzzation, and that the charges <br />as stated will 4:it?^_r*x youY agencies polica.es be paid. <br />~S~"G?~D I]ATE <br />TITLE GF Orr^FIC.E <br />I5' a.religicus oxga^ization, tha blinister, Priest. or Rabb„ must also sign. <br />APPROi'AL Cr i7Z:2=C'_":~_2 . <br />The above dues co not con~lict with any schedule yr planned Departmen'ta,l <br />progra..*1. <br />' DIRECTOR ' <br />ApPRCV1L CF ADVTSGRX COL~TCIL C:iAIfL*lAtd <br />I anprvve above anpli.cation, subject to dates and times being apprpved <br />. CHAT&~iPIDT <br />RATE Ak•:OCIVT A[)E laAXtdENi .~]['I -. - -- - ~ -- __ - <br />DAm., kLCc^.IV.~: - _ _ .. :. _ ... -- .:'. . AtdOTJ[JT ....... ~., a t_ .._ _ .. - <br />_. <br />D PA1'Mc,N'I' RECEIVED -- _ - - -.. - _ .. <br />--- <br />.. _ <br />SPECIAL NOTE5: - .. _~--:. ......-~ ... -,~ ... <br />APPLICATIONS Zr.AX B.~ 03TA2t7;.'a FROM ANY RECREATION STAFF MEMBERS , <br />