Phone *

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Date of Event *

What is the date and time you are requesting to use the facilities (Please allow two weeks for processing)

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DD

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I affirm that: *

I understand that the church does not allow its facilities to be used in a way that contradicts its faith or by persons or groups holding beliefs that contradict the church's faith

To the best of my knowledge the purpose for which I am requesting use of church facilities will not contradict the church's faith, and I commit to promptly disclose any potential conflict for which I am aware of become aware to church staff

I am not aware of any beliefs that are professed by me or the organization I represent and which is requesting use of the church's facilities that contradict the beliefs of the church. I agree to promptly disclose any potential conflicts in belief to church staff

I understand that upon approval of my facilities use request, I will need to provide a security deposit in the amount of $500, a certificate of insurance or at least $1,000,000 per occurrence, and any other fees required by the church

I understand that the church does not allow it facilities to be generally available to the public, and that my use of these facitlities is subject to the pastor's approval, which is conditioned in part on my agreement to the requirements in the "Church Facility Use Policy", a copy of which I have read and understood

I understand that I will be responsible for any damages to the church facilities resulting form this proposed use of facilities

Name *

First Name

Last Name

Date Submitted

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DD

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