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CITY OF RAMSEY <br />FACILITY USE PERMIT <br /> <br />Facility <br />Date requested. L. <br />Est. number in grbup <br /> <br />Function <br />Time-Indoor <br />Time-Outdoor <br /> <br />Organization , Phone <br />Address Verified Res. __ <br />Leader in Charge;. Phone <br /> <br />Non-Res. <br /> <br />Is this a youth grO, up? Yes. No <br />If so, what is your percentage of resident and not-residents participants. <br />Please provide a l~st to verify. % Ramsey % Other <br /> <br />Will participation in this activity be restricted in any way on the basis of sex, race or religious <br />'affiliation? Yas No <br />If yes, what resinS:nons? <br /> <br />Fees must be paid at time of application <br /> <br />LOCATION FEE KEY <br /> <br />Building <br />Shelter s <br />Field/Court <br />Field/Court w/ligfits <br /> <br />Damage Deposit ~ $75.00 (resident and non-resident) <br />Key Deposit - $1 ~.00 per ke> (resident and non-resident) <br /> <br />$. <br />$. <br />$. <br />$. <br />$. <br />$. <br /> <br />TOTAL FEE $ <br /> <br />Date paid. ~ Receipt Number ': Key returned <br /> <br />I, the Permit User/(s), have read and understand the Policies and Procedures for Park/Facility Use <br />as printed on the })ack of this fom~ and further agree that they shalt be strictly observed and accept <br />responsibility forlthe enforcement of them. In consideration of acceptance, I, the user(s), waive <br />and release any a~nd all rights and claims for damages against the City of Ramsey and agree to <br />protect, indemnify and hold harmless the City and its officers and employees from any and all <br />claims, liabilities,! damages or rights of action (directly or indirectly) while participating or using <br />the facilities cove/ed by this permit. <br /> <br />Signature of Responsible Person <br />Date: <br /> <br />Park Department <br /> <br />(FOR OFFICE USE ONLY) <br /> <br /> INDOOR <br />Date of App. <br />Res. ]'ion-Res. <br />Date issued <br />File number <br /> <br /> OUTDOOR <br />Date of App. <br />Res. Non-Res. <br />Date issued <br />File number <br /> <br /> <br />