Facility Use Request Form 1. Organization or person requesting use:name of the organization or the applicant2. Type activity:3. Activity Date: MM slash DD slash YYYY 4. Time of Activity: Hours : Minutes AM PM AM/PM Activity Day:5. Time church needs to be opened: Hours : Minutes AM PM AM/PM 6. An approximate time church can be closed: Hours : Minutes AM PM AM/PM 7a. Areas of the church to be used: Sanctuary Fellowship Hall Conf. Room Kitchen 7b. Another area of the church to be used not listed in 7a:8. An approximate number of attendees:9. Attendes: Adults Children 10a. Is this a recurring activity? yes no 10b. If yes, how often will activity take place? Weekly Monthly Quarterly Annually As Needed Other 10c. If the activity is recurring and will take place on the same day of the week, what day of the week will it take place? Sunday Monday Tuesday Wednesday Thursday Friday Saturday 10d. If another frequency, please input:11. Will food be served? yes no 12. Will the kitchen be used? yes no 13a. Will set-up be required? yes no 13b . If yes, in which space will the equipment be used? Tables Chairs Other 14a. Will audio/visual equipment be used? yes no 14b. If yes, in which space will the equipment be used? Sanctuary Fellowship Hall Class Room Conference Room Other 14c. If other, please input:14d. Will any needed audio/visual equipment be provided? yes no 14e. If yes, what audio/visual equipment is needed?15. Other comments:Signature of Applicant/Contact:TelephoneDate MM slash DD slash YYYY Signature of Second Applicant/Contact:TelephoneDate MM slash DD slash YYYY Email Note: if the activity is canceled, please notify the office at least 72-hours prior to the activity.This Section for Church Use Only Approved/Confirmed by__________________________ Approved/Confirmed date ________________________ The Assigned Trustee ___________________________ Trustee phone _________________________________ Items below are completed only for facility rentals Deposit Date _________________________________ Full Payment Date ______________________________ Applicant Notified by____________________________ Notification Date ________________________________ NameThis field is for validation purposes and should be left unchanged. Δ
