St. Paul's UMC Facility Use Request Form

Today's Date :

-- mm/dd/yy

Please provide the following contact information:

Name
Work Phone
Home Phone
E-mail

Event title:

Enter the start date of your event :

-- mm/dd/yy

Enter the end date of your event :

-- mm/dd/yy

Does this event occur more than once?

yes  no

When and how often does your event recur?

Enter the start time of your event :

Enter the end time of your event :

Enter the preparation start time of your event :

Enter the clean up end time of your event :

Estimated number attending

Would you like childcare? 

yes no

If Yes, how many children will attend? 

What is the age range of the children attending?

Select the room(s) you are requesting: 

Life Center Activity Room  Serendipity North          Life Center Kitchen        Serendipity South        
Loft North                 Loft South                 Shalom North               Shalom South             
Covenant Room              F-1 East Room              F-2 Brummet Hall           F-3 Music Room           
F-5                        Brummet Hall Kitchen       Sanctuary                  A-Frame                  
Annex                      A-1                        A-2                        A-3                      
A-4                        B-3                        B-4/5 Nursery              B-6                      
C-1 Library                C-7                        

Equipment/Personnel Needs: If you require a special setup, please provide a diagram to Mike Salvagio 14 business days prior to your event showing how tables, chairs, etc., are to be setup.)

TV/VCR/DVD                     Speaker Stand                  Overhead Projector             Sanctuary Sound System       
Life Center Sound System       Life Center Barbeque           Custodian                      Other (Contact Mike Salvagio)

---

For Facility Manager's use only:

______ Approved & Scheduled        Date __________        Initials ___________

cc:    ________ Custodian     ________ Requestor    ________ Childcare    ________ Web Calendar

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