St Paul Reservation Request Form

Reservation Request Form
St Paul Missionary Baptist Church
1201 N. 17th St. | Harrisburg, PA 17103
Tel. (717) 234-0037 | wordandspirit1@yahoo.com

*Please note all request forms must be approved by the
Church Administrator before advertising of event.
Today's Date*

MonthDayYear
Date
Name of Event*
Name of Ministry/Organization:*
Date of Event*

MonthDayYear
Date
Number Attending*
Program Start Time*

:HourMinutesAM/PM Option
Program End Time*

:HourMinutesAM/PM Option
Setup Date and Time*

MonthDayYear
DateHourMinutesAM/PM Option
Room(s) Requested*

Social HallConference RoomHenley ChapelSmall Dining RoomClassroom (#)Multi-Purpose RoomKitchenSanctuaryOther
Classroom # Requested
Cook needed?

YesNo
If no, Name of Cook
Do you need room set-up? (Available only for St Paul Church programs)

YesNo
Equipment Needed

Plates, cups, utensilsMicrophoneKeyboardScreensOrganOther
Tables #
Chairs #
Note - Chairs and tables may not be borrowed for use outside of St Paul.
Name of Person In Charge:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail:*
Phone:*
STATEMENT OF RESPONSIBILITY

The person in charge must be present at all times during scheduled event. All equipment, supplies, furniture, etc. must be returned to its appropriate place and the general area must be left in tidy condition. This is to encourage goodly stewardship of our church facilities. If these policies are not followed, future use may be denied.
Should be Empty:

STATEMENT OF RESPONSIBILITY