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CITY OF RAMSEY <br />FACILITY USE PERMIT <br /> <br />Facility <br />Date requested <br />Est. number in group <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 group? Yes No <br />If so, what is your percentage of resident and not-residents participants. <br />Please provide a list 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 />aff'fliation? 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/Facility Use <br />as printed on the back of this form and further agree that they shall be strictly observed and accept <br />responsibility for the enforcement of them. In consideration of acceptance, I, the user(s), waive <br />and release any and 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 covered 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. Non-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 />