Facilities Use Request (FUR) Form

Requester's Name

This address will receive a confirmation email

Phone

Event Name

Describe the event

Event Date:

If Multiple or Reoccurring please describe:

Starting Time:

Ending Time:

Enter Building Time: (for set-up))

Exiting Building Time: (after clean-up)

Building Access:

Estimated number of attendees

List any equipment you may need (# of tables, # of chairs, tablecloths, kitchen supplies, easel stands, TV, coffee maker, etc.)

If you have a preference on how the room is setup please describe here

Will you need the use of any technology in the sanctuary? (note: additional fee may apply) Yes No

If yes, please detail what you may need: audio system, microphones, projector screen, video recording, etc.

Will you need our safety & security personnel present for this event? Yes No

RESPONSIBILITIES FOR BUILDING USE

1. Collect all garbage into bags and place them in the dumpster at the west end of the parking lot.

2. Wipe off tables. If food or drink is involved, clean tables with a mild soap and water solution. If stains occur, please notify the church office so approved cleaning solution can be applied.

3. Return all tables, chairs, and other equipment to their proper place after the event. Return all rooms used to their normal setup.

4. If using the kitchen, wash and dry all dishes, utensils and accessories used and return these to their original locations. Take all extra food and beverages with you unless other arrangements have been made. Wipe counters and appliances.

5. Sweep/vacuum/mop floors as needed. Report any damage to the church office.

6. Remove any items put up on the walls, hung or set out in connection with the event.

7. Ensure that all lights are turned off in the areas that were used.

8. The Dome flooring is not designed for skateboarding, roller blading, bicycles, etc. Such activities are prohibited.

9. Exit doors, fire exits, fire pulls and fire extinguishers must remain unblocked at all times.

10. Shelter house use requires removal of all trash from the shelter house area to the dumpster.

11. If arrangements have NOT been made with Safety/Security for the building to be locked, the event sponsor must ensure that all individuals have left the building, all doors are locked and the alarm is activated.

12. Moving the piano, keyboard, or anything on the stage is PROHIBITED except by staff.

Do you agree to the above responsibilities

Yes No

Are you an active attender of the church? Yes No

Facility use payments can be made online at:
https://patnaz.breezechms.com/give/online

You can also make checks payable to Pataskala Church of the Nazarene and in your "memo" write "Bldg Usage." Facility use fees will be required to officially schedule the event. Thank you!

The person/organization requesting use of this facility is responsible for set up, clean up and return to normal set up of the facility (see Responsibilities of Building Use). Additional fees will apply if the building is left in an unsatisfactory manner. The person/organization requesting use of this facility hereby absolves the Church, its Pastors, leadership, members, representatives and/or people from any liability for theft of personal property or personal injury to any individual resulting from the use of the Church facilities and agrees to be responsible for any property damage that results from the use of the facilities. It is the Requester/Organization's responsibility to report any property damage or personal injury to the Church office as soon as possible.

I acknowledge I have read and agree to the Building Use Responsibilities and Fee Schedule. By entering my name in the box below, I am providing my digital signature on this form.

Requester's Signature:

Today's Date:

*FOR OFFICE USE ONLY*

Office Payment Details (Amt Received, Date Received, and Initials):

Office Notification Date, Comments, and Initials

Facilities Use Request (FUR) Form

Description

Please Fix the Following