Non-Gym Scheduling Request Form

Non-Gym Scheduling Request Form
Please fill out this form with your request for use of our facilities. Our Campus Scheduling Team meets every Monday afternoon to review all inquiries. The use of St. Peter’s facilities will be permitted to individuals and groups with values and beliefs consistent with our Mission.
TODAY'S DATE*

MonthDayYear
Date
ORGANIZATION/EVENT NAME*
DESCRIPTION OF EVENT*
CONTACT PERSON*
PHONE*
EMAIL*
example@example.com
USAGE
Select usage type*

Personal (member)Personal (non-member)Community Non-ProfitCommunity For Profit
EVENT DATE
Select event type*

Single DateMultiple DatesRecurring Event (ex: daily, weekday, monthly, 2 Tuesday)
Single Date*
Multiple Dates (Click the + button to keep adding more dates)*
Recurring Event (List details and any exceptions to the recurring event - ex: daily, weekday, monthly, 2nd Tuesday)
EVENT TIME
Actual Event Time*

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
How many minutes are needed for setup?*
How many minutes are needed for cleanup?*
EVENT SIZE
Number of adults*
Number of children:*
If children present, who is supervising? (Requires CPP certification for SPL groups)
ROOM REQUEST
Select the room/s that you would like to request. (For weddings/sanctuary use, contact Julie Terry - jterry@stpeters-columbus.org)*

Cafeteria/KitchenGuatemala Room (monitor - max 8)India Room (monitor - max 24)Library (monitor - max 24)2164 (monitor, kitchen - max 80)The Park (projector - max 60)No PreferenceOther
SPECIAL REQUESTS
Select all that apply*

NoneSpecial room or seating arrangement neededComputer (*may require a technician fee for personal/non-ministry usage)LCD Projector (*may require a technician fee for personal/non-ministry usage)Microphone (*may require a technician fee for personal/non-ministry usage)DVD PlayerAdditional needs:
Who will be operating the above equipment? *
FOOD
Will food or refreshments be served?*

YesNo
If food is served, who is providing/serving?*
Please list any special needs for food serving:*
CAFETERIA/KITCHEN SPECIFIC GUIDELINES
Please be aware that the cafeteria kitchen equipment cannot be used unless a kitchen staff worker is present for the function.
1. Items that can be used without a kitchen worker: utensils, pots, pans, sinks, bowls, pitchers, plates, rolling carts, etc.. Please wash all items and return to the proper place and wipe down all counters.
2. Items that cannot be used without a kitchen worker: dishwasher, ovens, mixers, warming wells, steamers, warmer, cooking pot, griddle top, and fryers.
Please initial. I understand and agree with the Cafeteria/Kitchen specific guidelines*
HOLD HARMLESS AGREEMENT AND OVERALL FACILITY USAGE GUIDELINES
1. The Individual/Group and its members/guests agree to compensate, release and hold harmless St. Peter’s Lutheran Church, its directors, officers and employees from any and all claims, accusations or damages for any accident, actions, injury or illness arising out of the use of facilities, equipment and/or participation in activities while on St. Peter’s property.
2. The Individual/Group Representative shall be in attendance throughout the stated hours and dates of usage and is to be responsible for the proper conduct of all Group members/guests and proper care of the facility.
3. All children and youth age 17 and under must be supervised by the Individual/Group Representative at ALL times .
4. St. Peter’s sponsored events must follow our Child Protection Policy.
5. The Individual/Group members/guests will care for St. Peter’s property and agree to reimburse St. Peter’s for any costs for repair or damage to property.
6. Firearms are prohibited in our building during school activities. (Contact Mike Hinckfoot, Executive Director with questions.)
7. Alcoholic beverages, tobacco products, or iIllegal drugs are prohibited at all times on our campus.
8. We ask you to complete clean-up no more than 30-minutes after the event ends.
9. Additional cleaning fees post-event may be charged if the facility is not restored to its original state.
Please initial. I understand and agree to the usage guidelines as listed.*
CLEAN UP
Please initial. I understand that it is my responsibility to return the room back to original configuration, not the custodians.*
By signing below, I agree to the conditions stated in the St. Peter’s Facility Scheduling Request Form.
Signature:*

Clear
Date:*

MonthDayYear
Date
For any questions, please contact Molly Humes at

mhumes@stpeters-columbus.org or 812.372.1571

St. Peter’s Lutheran Church, 719 5th Street Columbus, IN 47201
Should be Empty:

Non-Gym Scheduling Request Form

USAGE

EVENT DATE

EVENT TIME

EVENT SIZE

ROOM REQUEST

SPECIAL REQUESTS

FOOD

CAFETERIA/KITCHEN SPECIFIC GUIDELINES

HOLD HARMLESS AGREEMENT AND OVERALL FACILITY USAGE GUIDELINES

CLEAN UP