Facility Request Form

• • Function Date *
    
    When is your event
• • Start Time *
    
    The time of day that you will need the building available. Include am or pm.
• • End Time *
    
    The time of day that you will be out of the building. Include am or pm.
• • Number of Adults *
    
    Adults attending event.
• • Number of Children *
    
    Children attending event.
• • Explanation of function and activities including special requirements or arrangements *
    
    How will the facility be utilized.
• • Individual, Group or Organization requesting *
    
    Name of Individal, Group or Organization.
• • Contact Person *
    
    First
    
    Last
• • Phone Number *
    
    
    
    
    
    
• • Fee Table *
    Sanctuary No chairs $250.00
    Sanctuary With Tables and/or Chairs Set Up $250.00 (Requires Chair/Table setup to be checked below)
    Foyer $125.00
    Fellowship Hall Downstairs $100.00
    KITCHEN $125.00 (indicate equipment needed below)
    CLASSROOM $30.00 (Indicate room number below)
    Athletic field $30.00
    OTHER (if other is checked please give details below) ($ amount to be determined)
    AUDIO EQUIPMENT (Indicate equipment needed in box below) ( ** ) indicates when Technician is required and charges will apply.
    Technician ($20.00 per hour)
    Chair/Table Setup ($20.00 per hour; download and submit setup diagram found above)
    Check all items that will be used.
• • If KITCHEN is selected above check the items that will be needed
    Stove(s)
    Refrigerators(s)
    Coffee Maker
    Coffee carafe
    Dishes/Silverware/Pot & Pans
    Nesco roaster(s)
    Check items that will be used
• • If CLASSROOM is checked above; indicate room number
    
    Classroom number 1-27.
• • If OTHER is checked above; please give details
    
    Provide details.
• • If AUDIO EQUIPMENT is selected above check the items that will be needed
    Tape recorder
    Overhead projector
    TV/VCR/DVD unit
    Audio Recording ( ** ) Technician charge will apply.
    Projection System ( ** ) Technician charge will apply.
    Sound System
    Microphones
    AV Computer ( ** ) Technician charge will apply.
    Stage lighting ( ** ) Technician charge will apply.
    Check equipment that will be needed.
• • Reservation will not be held until a deposit of $200.00 is received in the Church office *
    Custodial/Cleanup - $100.00 Deposit; $15.00 per hour used.
    Damage Coverage - $100.00 Deposit (fully refunded if not required)
    Acknowledge by checking both deposit boxes. Required with every Facility request.
• • Setup diagram (when applicable) is required to hold reservation
    I agree
    Acknowledge by checking box.
• • I have read and agree to all policies and procedures *
    I agree
    I disagree
    Read policies and procedures. Document can be downloaded above.
• • Email
    
    Email address for response and next steps.
• • Name of person who has read and agreed to policies and procedures *
    
    First
    
    Last
• • Date *
    
    Date form was agreed to and submitted

Authentication Text*
(Enter the text in the image above into this field.)

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