Room Use Request Form
Chalice Unitarian Universalist Congregation
2324 Miller Avenue, Escondido CA 92029
(760) 737-0393
www.chaliceuucongregation.org
office@chaliceuucongregation.org
Email address *
EVENT NAME/TITLE *
Your answer
GROUP/ORGANIZATION *
Your answer
RESPONSIBLE PERSON *
Your answer
TELEPHONE: *
Your answer
MAILING ADDRESS *
Your answer
EMAIL ADDRESS *
Your answer
WEBSITE
Your answer
CHECK ROOM(S) NEEDED *
Required
EQUIPMENT NEEDED (may require additional charge)
DATES REQUESTED *
Your answer
NUMBER OF ATTENDES *
Your answer
EVENT TIMES *
Please list ACTUAL EVENT TIME and how much time you need before the event to set up, and how much time after to clean up.
Your answer
Additional Comments:
Your answer
Alcoholic Beverage Policy:
Alcoholic Beverages may not be sold but may be served in exchange for a free will donation. The group or individual user is solely responsible for compliance with laws pertaining to alcoholic beverages and the sobriety of their guests. If alcohol will be served at the event, a plan for keeping minors from using alcohol must be submitted in writing and approved by the Office Administrator. Non-alcoholic beverages must be offered.
Proof of Insurance:
Groups are responsible for obtaining separate insurance for activities not covered by Chalice's liability insurance.
Condition of Facility:
All Chalice facilities must be returned to their original set-up at the conclusion of the event.
Signature: *
Your answer
DATE SUBMITTED *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.