Facility Use Request
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Description of Activity *
Date(s) of Activity *
MM
/
DD
/
YYYY
Time(s) of Activity *
Name of Person Responsible *
Facilities Requested *
Approximate Number of People Attending *
Phone *
Email *
Sink or  refrigerator needed?
Request access to all kitchen equipment
Church member contact
(Leave blank if unknown)
Building usage fees are $200 per day for the fellowship hall, $150 for the sanctuary, and $100 for a Sunday School Room or the parlor.
Would you like the trustees to consider a fee waiver? If so, please explain.
Electronic Signature
Write your name to indicate that you will follow the guidelines outlined in the building use policy. 
 *
Submit
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