Date of Application

Date Received

Requested Date(s)

Requested times: From

To

Actual time of event: From

To

Name:

Ministry

Phone Number: Home

Work

First Choice: Check All that Apply

Building Request

Requested Room(s)

Second Choice: Check All that Apply

Building Request

Requested Room(s)

Number of Classrooms

Number of Participants for event

Church personnel required

Provide a brief but thorough overview of the event or activity

Signature

Date

* Each user of our facility must restore it to the original condition after usage. As a user your responsibility is to dispose of the trash, sweep the floor, turn off the lights, close doors, and remove any food or supplies utilized during the usage of facility.

NOTE: THIS FORM IS REQUIRED FOR ANY EVENT/ACTIVITIES NOT REGULARLY SCHEDULED FOR CHURCH BUILDINGS

-----------------FOR CHURCH OFFICE USE ONLY----------------

Approval for:

Approved signatures:

Pastor:

Chairman, Deacon Ministry:

Chairperson, Trustee Board:

-----------------DENIED REQUEST----------------

Date:

Name of Requester:

Facility Requested:

Date Requested: