BUILDING USE REQUEST FORM

Name

This address will receive a confirmation email

Phone

For what purpose or event are you requesting space?

Which room(s) whould you like to use? (Check all that apply.) Connection Cafe All Purpose Room Kitchen Auditorium Large Adult Classroom Small Adult Classroom Jr. High Classroom Children's Classroom

Date(s) that you need the space:

What time do you need access to the space (for setup, etc.)?

Event beginning and ending times:

Do you need to use any A/V equipment? (Check all that apply.)

Sound Video Live stream None

Please note that the audio, video and live stream equipment must be operated by staff-approved individuals, and you may be required to pay the technician(s) to operate the equipment for your event.

We ask that you follow these guidelines when using our facility for your event:

*Please gather all trash after the event and carry it out to the dumpster on the north end of our property. Clean up any spills and vacuum if necessary.

*Please do not leave food items in the refrigerators or on the kitchen counters. Take all your leftovers with you.

*Please reset all the spaces so that chairs, etc., are where they were when you arrived.

*Please make sure all lights are off (except those marked to be left on at all times) and doors are locked when you leave.

By typing your name in the space below, you are agreeing to the guidelines listed above.

Name / Electronic Signature

Date of submission:

BUILDING USE REQUEST FORM

Description

Please Fix the Following