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CITY OF RAMSEY <br />FACILITY USE PERMIT <br /> <br />Facihg' <br />Date requested <br />Est. number in group <br /> <br />Function <br />Time-Incioor <br />Time-Oumoor <br /> <br />Organization .. Phone <br />Address Verified Res. <br />Leader in Charge Phone <br /> <br />Non-Res. <br /> <br />Is this a youth group? Yes No <br />If so, what is your percentage of resident and not-residents pamcipants. <br />Please provide a list to verify. % Ramsey % Other <br /> <br />Will participation in this activity be restricted in an>, wa), on the basis of sex, race or religious <br />afffl.iation? Yes No <br />If yes, what restrictions? <br /> <br /> Fees must be paid at time of application <br /> <br />LOCATION FEE KEY <br /> <br />Building $ <br />Shelter $ <br />Field/Court $ <br />Field/Court w/lights $ <br />Other $. <br /> <br />TOTAL $. <br /> <br />Date paid Check # Cash <br /> <br />I, the Permit User(s), have read and understand the Policies and Procedures for Park/t::acilir3, Use <br />as printed on the back of this form and further agree that the3' shall be smcfly observed and accept <br />responsibility for the enforcement of them. In consideration of acceptance, I, the user(s), waive <br />and release an3, and all rights and claims for damages against the CiD' of Ramsey and a~ee to <br />protect, indemnify and hold harmless the CiD' and its officers and employees from any and ail <br />claims, liabilities, damages or rights of action (d/recfly or indirectly) while participating or using <br />the facilities covered by this p~zmit. <br /> <br />Signature of Responsible Person <br />Dam: <br /> <br />Park Depamaaent <br /> <br />(FOR OFFICE USE ONLY) <br /> <br /> INDOOR <br />Date of App. <br />Res. Non-Res. <br />Date issued <br />File number <br /> <br /> OUTDOOR <br />Date of App... <br />Res. Non-Res. <br />Date issu~ <br />File number <br /> <br /> <br />