Form G201 - Facility Use Program/event Request Form - Evangelical Church printable pdf download

File #: G201

Orig. Date: 4-11-94

Mod. Date: 10-02-09

Rev. Date:

_____________________________________________________________________________________

FORM: FACILITY USE PROGRAM/EVENT

(For use with Facility Use Policy #D1201-1, Kitchen Use Guidelines #D1201-8, and Equipment Use Guidelines #G202)

Event/Type: __________________________________________________________________________

Date Request Submitted: ___/___/___

Requested By: _____________________________________

Proposed Date and Time:

Date(s) From: ___/___/___ To: ___/___/___ Week Day: M

Su (circle)

Event Start Time ____:____ __m End Time: ____:____ __m Number People Expected: _____________

Set Up Date: ___/___/___ & Time: ____:____ __m Week Day: M

Su (circle)

Clean Up Date: ___/___/___ & Time: ____:____ __m Week Day: M

Su (circle)

Additional Information:

Main Contact Person: _______________________________ Home Phone: (_____)_________________

Cell Phone: (_____)____________________E-mail: ___________________________________________

Address: _____________________________________________________________________________

Facility Requirements:

Street Level (SL)

 Auditorium/Sanctuary (Capacity: 380/635)

 Gym (Capacity: 344/600)

 Kitchen

 Library

 Other _________________________________________________________________________

Lower Level (LL)

 N. Fellowship Hall (Capacity: 64)

 S. Fellowship Hall (Capacity: 56)

 Kitchen

 Fireside Room (Capacity: 20/40)

 Café 19 (Capacity: 75)

 Other _____________________

Special Requirements: (One month’s notice requested; changes not allowed within 1 week of event)

Room Set-up

_________________________ __________

(number/type/set-up of tables, chairs, stage, lectern, etc.)

_____________________________________________________________________________________

Tech Media - Lights/Sound/Multi-Media

(Must use church-approved technicians)

_____________________________________________________________________________________

Insurance Information: Organizations are required to show proof of insurance equivalent to that carried

by SEFC and must name SEFC as an additional insured. Date insurance certificate received ___/___/___

Person Completing This Form:

All information is accurate to the best of my knowledge. On behalf of the persons or group using church

facilities, we agree to abide by all applicable guidelines.

__________________________________

_________________________

______________________

Signature

Day Phone

Date

SEFC Approval by:

__________________________________ ______________________________ __________________

Signature

Position

Date

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Form G201 - Facility Use Program/event Request Form - Evangelical Church

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