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Facility Date requested) Est. number in group CITY OF RAMSEY FACILITY USE PERMIT Function Time - Indoor Time - Outdoor Organization Phone Address Verified Res. Non-Res. Name Phone Address Verified Res. Leader in Charge Phone Non-Res. Is this a youth group.'? Yes No ~ If so, what is your percentage of resident and non-resident participants. Please provide a list to verify. % Ramsey % Other Will participation in this activity be restricted in any wa), on the basis of sex, race or religious affiliation? ~ No ~ Yes If yes, what restrictions? Fees must be paid at time of application LOCATION Building $ Shelter $ Field/Court $ Field/Court w/lights $ Other $ FEE KEY TOTAL $ Date paid Check # Cash I, the Permit User(s), have read and understand all the policies and procedures for use of Park Facilities as printed on the back of this form and further a~ee that the3, shall be strictly observed and accept responsibility for the enforcement of them. In consideration of acceptance, I, the user(s), waive and release an3, and all rights and claim for damages against the City of Ramsey and a~ee to protect, indemnify and save harmless the C/ty and its officers and employees from an3, and all claims, liabilities, damages or rights of action (directly or indirectly) while part/c/paring or using the facilities covered by this permit. Signature of Responsible Person Date: Park Department (FOR OFFICE USE ONLY) INDOOR Date of App. Res. Non-Res. Date issued File number Facility Page Date of App. Res. Date issued File number Use Permit t of 11 OUTDOOR Non -Res.