Facility Use Request Form

Today’s Date:______________
Contact Name:_____________________________________________________________
Representing Group:_______________________________________________________
Requesting Date:__________________________________________________________
Alternate Date:___________________________________________________________
Your Phone Number:________________________________________________________
Your Email Address:_______________________________________________________

Requesting Time:__________________________________________________

Please check this box if you will be in the church after midnight and/or before 6:00 a..m. (Please note: when requesting your time, include time needed for preparation and cleaning up. This is the entire time that you will be using the space.)

Do you require set-up & breakdown of the room? ¨ Yes ¨ No

Please check all that apply. A map is located on the other side of this page for your reference.

Downstairs Rooms:
• 101
• 102
• 103
• 104 & 105
• 106
• 107 & 108
• 109
• 110
• 115
• 116
• 117
• 118
• 119
• 120

Upstairs Rooms:
• Social Hall A
• Social Hall B
• Social Hall C
• Kitchen
• Sanctuary
• Choir Loft
• Back Lawn
• Front Lawn
• Parking Lot

Additional Needs:
• Overhead Projector
• Film Screen
• TV/VCR
• Organ
• Piano
• Film Projector
• Chairs #______________
• Tables, round #_________(8 available)
• Tables, rectangular #________(5 available)

Social Hall Use Fee:
• Member $50.00/4 hours
• Non-Member $75.00/4 hours

Kitchen Use Fee:
• Member & Non-Member $25.00

Classroom Use Fee:
• Member $20.00/3 hours
• Non Member $30.00/3 hours

Set-up & Breakdown Fee:
• $15.00/hour minimum 2 hours

*If you are representing the church, there is no fee for use of rooms or additional needs.