DEPARTMENTAL FACILITY RESERVATION REQUEST

**THIS FORM IS TO BE USED BY CHURCH MEMBERS ONLY**

PLEASE SUBMIT REQUEST AT LEAST "1 WEEK PRIOR" TO DATE NEEDED

Today's Date

mm/dd/yyyy

Department:*

Contact Person:*

Phone Number:*

Email Address:*

Date Requesting (1st Choice)*

mm/dd/yyyy

Date Requesting (2nd Choice)

mm/dd/yyyy

Reason for Request:*

Describe Other:

Name of Event:*

Event Time (Beginning & Ending):*

Rooms/Area Requesting:*(Please Select ALL Rooms/Areas Needed)

Junior Rm

Primary/Computer Rm

Kindergarten Rm

Mother's Rm

Multipurpose Rm

Kitchen

Sanctuary

Courtyard

Parking Lot (for Car washes, Yard sales, etc.)

Will you need to enter the room(s) before beginning date and/or time of the event?

If "Yes" What Time?

Please Type In "All" Rooms with Dates & Time (Beginning & Ending) You Need Early Access To:

Will you need time after the event for cleanup?

If "Yes" Until What Time?

Will your Event be Recurring?

If Recurring give Details:

No. of People Expected:

How Many Tables Needed?

How Many Chairs Needed?

Additional Needs:(Please Select All Additional Needs)

None

PA System

Portable Projector

Screen

Access to Refrigerator

Access to Freezer

Additional Comments:

16th Street

Department Facility Reservation Request