FUR Form - Facilities Use Request Form

NOTE: Ministry events and weddings may submit your request(s) beyond six (6) months in advance. All other request(s) may not be submitted more than six (6) months in advance. Sunday (non-ministry) request(s) are available from 12:30pm to 3:30pm only. Any time or date changes will require the submission of a new form. Approval or denial of the request will be provided by email, text, phone or in writing.

Requester's Name - Must be an accountable adult

Sponsor and/or Ministry Name

This address will receive a confirmation email

Phone

Event

Describe the activity to be held

Event Date:

Multiple Dates:

Check Multiple Days: Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Ending Date (If recurring activity, there must be an end date)

Recurring - choose one

One time only Weekly Bi-weekly Monthly Bi-Monthly

Event Time:

Enter Building Time: (for set-up))

Exiting Building Time: (after clean-up)

Building Access:

Estimated number of attendees

Equipment requested for activity: (select all that is needed) Based upon review and approval Tables Chairs Coffee Maker(s) Coffee Dispenser(s) TV/DVD Internet Connection Portable Sound System Stage Lighting (by remote request) Hotdog Roller

Please explain: i.e. # of tables; # of chairs, etc.

RESPONSIBILITIES FOR BUILDING USE

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). 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.

FEES FOR NON-MINISTRY EVENTS:

Due to the high cost of maintenance, janitorial and utilities, it is necessary for building users to help defray such costs.

A $50.00 deposit is required at the time this form is submitted. The deposit will be returned if the date is NOT approved. $50.00

For Active Congregation:

Payment

Amount

For those outside the congregation:

Amount

Please make your checks payable to Pataskala Church of the Nazarene and in your "memo" write "Bldg Usage"

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

Date

FOR OFFICE USE ONLY

Office: Schedule indicates the date(s) and time(s) are available: Yes No

Deposit Amount Collected (if required) Yes No N/A

Comments:

Janitor Signature & Date

Comments:

Safety/Security Signature & Date

Comments:

Technology Signature & Date

Comments:

Office Notification Date and Initials

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

FUR Form - Facilities Use Request Form

Description

Please Fix the Following