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APPLICATION FOR USE OF BUILDING& GROUNDS <br /> ORONO ISD#2'7n8 <br /> Name of group or individual requesting use <br /> Requesting which facility?0 M d gb What type of room or field? l- �I (" <br /> Purpose of use ? am/,,iA <br /> VHow many people attending <br /> Single Meeting Date <br /> Day � R �� ( � . <br /> z1y�,-���Date Hours(from)L� �(to) <br /> Series of Meetings <br /> Days Dates Hours(from) (to) <br /> Special need uired such as tables,chairs,AV equipment,food service,etc. Please list in detail: <br /> Permission to bring into building or onto ground these items(please list in detail): <br /> Will you charge fees for this event? If so,how much for adults and how much for students <br /> What will the proceeds be used for? �� r 1 r ( r i s(t -i�( <br /> Rental charge(if any)will be made in accordance with the schedule p nted in policies governing rentals. Payment shall be made to Orono <br /> Community Education upon receiving an invoice from Orono Community Education. Buildings will not be open except upon presenting to the <br /> custodian or building supervisor an official permit issued by the Community Education Office. Employee charges include direct and indirect(fringe <br /> benefits)cost of employees are in addition to school facilities fee charges. Employee charges for overtime(beyond normal working hours)will be at <br /> double the normal employee salary and fringe benefit rate. <br /> The undersigned who is to be in charge of the group is 21 years of age or over. This person agrees that they will be responsible to the <br /> Board of Education for the use and care of the school property.They further agree that the character of use will conform with that <br /> stated in the application,and that they will make the required payment for any damages occurred during use. They also understand <br /> that the custodian cannot permit the use of the building except upon representation of an official permit granted by Orono Community <br /> Education. <br /> Signature of person in charg <.en�— Printed Name <br /> Address d!'e' /�/�T�LlS4/g , ��f/ �*�+/ S%fit A,•a S(%City_�*00l/$ Zip <br /> Home#Q:.:r4 )-02 Z 4?Yy Work#(GSL <br /> Cell# E-mail Address IA"ieSaT <br /> Liability Insurance Coverage Policy# Check here if applicant does not have liability coverage <br /> *Office Use—Not to be filled in by applicant <br /> Date received $15 Permit Processing Fee Paid—Permit# Permit Sent Bill Sent <br /> Approved( ) Not Approved( ) Principal Signature Date <br /> Remarks <br /> ZO Co PKWlu nt ty Return completed application to: Orono Community Education <br /> 705 N.Old Crystal Bay Rd <br /> Education Long Lake,MN 55356 <br /> 0 Orono Public Schools or fax to 952-449-8359 <br />