MANCHESTER CHURCH OF THE BRETHREN
Facilities Reservation Request Form
Date of Request ________________taken by______________
Name or Organization:________________________________
Contact Information:
Address ___________________________________________
Telephone ____________________ e-mail _______________
Cell phone:____________________ other:________________
If this is a wedding, who is the presiding pastor? ____________
Event Date(s): ______________ Event Hours: ____________
Total Hours: ________________
set-up lead time/clean-up, tear down time_________________
Key Policy: Sign out a key (if you’ll need one) shortly before your event. Be sure to test it out. Be sure to lock up afterwards.
Facility Rental Fees Involved (Fees reduced for members of the church family)
Total Fee: $___________ Key# Issued:_________
Deposit: $___________ Key returned__________
Balance Due: $___________ amount: _____________
Receipt # __________check #________Date:_______________
Confirmation date:_______________ Confirmed by:_________
Facility Use Agreement
Activity: ___________________________________________
Areas of Activity:_____________________________________
(please notify the church office if your event is cancelled: 260-982-7523)
Extra Needs (light, sound, equipment) ____________________
If necessary the church agrees to provide a contact person (to be paid $15/hr.) to enable the following:
- Open and close the building
- Assist with set-up and tear-down
Those using the facility agree to comply with the following statements:
1. We understand that two adults* (one being age 21 or older) will be present with our group at all times (*unless permission has been given to have only one.)
2. We understand that our activity will remain in the above stated area(s) of activity.
3. We agree that responsible adults will always be the last to leave.
4. We agree to return property to its proper place, shut off the lights, and lock up.
5. We understand that if conduct or activities in our building are not consistent with the beliefs and policy of the Manchester Church of the Brethren, the church reserves the right to terminate this agreement at any time.
6. We understand that we are responsible for any damage to the facility during our activity.
7. We agree to notify the church or after hours **contact person in case of an emergency or problems concerning the facility. **_______________________________________________
8. We understand that NO PETS are allowed in the facility.
9. We understand that the church is not responsible for lost items.
10. We understand that the church is not liable for any injury which occurs during the agreed activity.
We have read the above statements and agree to comply
Signature:______________________________ date:________
Address: ______________________________ phone_______
Manchester Church of the Brethren, phone: 260-982-7523, fax: 260-982-7525, manchestercob@gmail.com
(revised 05-19-2011)
