PROPERTY USE AGREEMENT and RELEASE FORM

Name of Organization

Contact Person*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Name of Organization's Event*

Date Requested*

Event Start Time*

Hour Minutes

AM/PM Option

Event End Time*

Hour Minutes

AM/PM Option

Frequency*

One Time OnlyWeeklyMonthlyOther

If weekly or monthly, which day of the week?

End Date, if repeated event

Approximate Number of Participants*

Will food or drink be served?*

YesNo

Room(s) Requested*

Equipment Requested*

Piano/OrganSound System (only available in sanctuary)Projector ScreenNo equipment needed

A building key is available for pick-up to access the building outside of office hours (Monday to Friday, 9 AM to 4 PM). Will you need to borrow a key for your event?*

YesNoMaybe

Describe in detail the type of event you will be bringing to our facility.*

If you are a non-synod group, have you applied for a certificate of insurance?*

YesNoI am a synod associated group

This Release and Indemnity Agreement is between Northeastern Pennsylvania Synod
and {nameOf} (for use of the property described above for meetings and other activities.)

NOW, THEREFORE, in consideration of Northeastern Pennsylvania Synod permitting the organization or individual(s) to use the property described herein, the organization or individual(s) agree(s) as follows:

1. Organization or individual(s) hereby indemnify, hold harmless, releases, and discharges Northeastern Pennsylvania Synod and its administrator, directors, agents, officers, members, volunteers, and/or employees, from any and all liability, claims, demands, losses or damages arising out of the use of the property.

ACCEPTANCE OF RESPONSIBILITY
I/We agree to be responsible for the conduct of those coming to or participating in the activity for which this application is being made, and for any damage beyond normal wear and tear which may occur as a result of this activity. I/We will remove all signs posted by my/our group after the meeting has ended. I/We further agree that the church property will be used in accordance with the Rules and Regulations of the organization and I/We hereby consent to the Release and Indemnity Agreement.
Signature

Signature*

Print Full Name*

First NameLast Name

PROPERTY USE AGREEMENT and RELEASE FORM

IMPORTANT

PLEASE NOTE

Certificate of Insurance Requirements

Release and Indemnity Agreement