1.         Date:  6/29/2017

     (Group or individual requesting use)

2. Address:     Telephone (reqd): 

3. Date(s) Requested:  Start date:     End date: 

4. Time of day: Begin:    End: 

5. Facilitator: 

6. Consultation  (Required for items 7, 8 & 9)  :  Date        Time 

7. Facilities needed (please check all that you plan to use):

           Fellowship Hall                                            Set-up Tables and chairs

           Kitchen                                                       Library

           Classroom(s) How many?          Set-up Classrooms

8. Equipment needed:  Where needed 
 

            TV/VCR/DVD                 BOOM BOX                     OVERHEAD PROJECTOR/LED

            POWERPOINT                SOUND SYSTEM             COFFEE POT(S)

9. Service needed:      SECURITY           CUSTODIAN

Use Guidelines.  Signature of this form indicates acceptance of all applicable fees and guidelines.

Please explain activity to be held:

Estimated number of people:  

The person/organization requesting the use of Church facilities hereby absolves the church, its pastors, leadership, members, or people of any liability for personal injury to any individual resulting from the use of the church facilities and agrees to be responsible for any property damage that results during the use of the facilities. Please report any damage to the church office promptly. The group or individual using the facility is responsible for returning the area(s) to the same condition as before use.

Signature of Responsible Party       Date