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1
Terms and Conditions
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2
Name of individual/group requesting facility use:
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3
Phone #
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4
Email
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example@example.com
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5
Calendar Date Requested
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Date
Month
Day
Year
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6
Time
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Minutes
AM
PM
PM
AM
PM
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7
If recurring Start date
/
Date
Month
Day
Year
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8
If recurring End date
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Date
Month
Day
Year
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9
Type of program
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10
I have access to the building:
Please Select
Yes
No
Please Select
Please Select
Yes
No
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11
Facility/services needed (please list all rooms/services you are requesting):
*
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Sanctuary Classrooms
Fellowship Hall
Small Kitchen
Choir Room
Parking lot
Van
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Sanctuary Classrooms
Fellowship Hall
Small Kitchen
Choir Room
Parking lot
Van
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12
Estimated number of people involved
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13
Estimated Funding Requested:
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14
CONTACT PERSON RESPONSIBLE
First Name
Last Name
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15
Date
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Date
Month
Day
Year
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16
Please attach additional pages with supporting documentation.
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17
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