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CITY OF RAMSEY <br />FACILITY USE PERMIT <br /> <br />Date requested t..% dua. o¢:_. tq~q~k _,~t: ..~,,,_¢.~ime-l,..nd .o~r_ <br />Est. number in group [, ¢¢..~:~ "-- r'rf t/4 ~,Iime-uumoor <br />Organizadon ~5v',.t<-.-~X'~ [~t~o% C~L~ Phone <br />Address p~z> ~'-~..>,~ .-q.-'?, l , ~ c',.,4~-.-q.g"-~ Verified <br />Leader in Charge c~¢,~-_.~ <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 /> Res. Y( Non-Res.~ <br />Phone c/D:'?- ~q~¢o <br /> <br />Will participation in this activity be.,re.$rricted in any way on the basis of sex, race or religious <br />affiliation? Yes No)q. . <br />If >,es, ,.,,,hat restrictions? <br /> <br />Fees must be paid at time of application <br /> <br />I <br />I <br />I <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 <br />I <br /> <br />I <br /> <br />t, 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 a~ee to <br />protect, indemnify and hold harmless the City and its officers and employees from any and alt <br />claims, liabilities, damages or rights of action (directly or indirectly) while participating or using <br />the facilities covered by this permit. <br /> <br />Sigdriature ot~/Responsible Person 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 />I <br />I <br />I <br /> <br /> <br />