Building Use Form
1020 South Valley Forge Road Lansdale, PA 19446 215-855-1643
Building Use Form This form must be filled out and returned to the Church Office no less than 2 weeks prior to your event. Groups that have requested a date and time AND have returned a Building Use Form will have priority. Name of Organization/Group ________________________________________________________________ Responsible Party _____________________________________ Phone_______________________________ Address __________________________________________________________________________________ Email ______________________________________ Preferred method of contact ____________________ Event Name and Description ________________________________________________________________ __________________________________________________________________________________________ Date(s) Requested ____________________________Start Time_____________ End Time______________ Purpose of event _____ Church Sponsored Event _____ Member Use _____ Community Organization/Non-profit _____ Other
_____ Non-Member
Frequency of event _____ One Time _____ Monthly _____Weekly _____ Multiple Days Room(s) Requested ____ Fellowship Hall
____ Kitchen
____ Lounge _____Sanctuary
____Education Wing
____ Reichley Room
____ Full Facility
____ Other ____________________________________
Anticipated Number of Participants _____________________ Will Participants be Charged a Fee _____Yes
_____ No
Will Food or Drink be Consumed _____ Yes
_____ No
Special Needs/Setup Instructions __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Page 1 of 2
As of April 2016
Building Use Form (Continued)
_____ I hereby acknowledge that I have read the Building Use Policies and guidelines for Christ United Methodist Church and I agree to abide by them. _____ I agree to comply with the guidelines for the use of Church Facilities and assume responsibility for following all the guidelines. _____ I understand that I am responsible to return the room(s) to the set up that I found it in. If there is damage or additional cleanup needed I understand additional fees could be assessed. _____ The person/organization requesting the use of Christ United Methodist Church facilities hereby absolves the church, its pastors, leadership, trustees, members, or people of any liability for personal injury to any individual resulting from the use of the church facilities and agrees to be responsible for any property damage that results during the use of the facilities. Please report any damage to the church office promptly at 215-855-1643
_______________________________________________________ Signature of Responsible Party
Date: ______________________
_______________________________________________________ Printed Name **If you are an organization or business please provide a certificate of insurance to the church office.** For Office Use Only Room Use Category ___________________________________________________________________________ Date Received ___________________
Fee ______________________
Date and Time of Event ____________________ No Conflict □ ___________ Fee Paid □ Amount Received, Date and Initials __________________________
□ Request Approved
□ Request Denied
Approved By _______________________________________
Notes _______________________________________________________________________________________ Applicant Notified □ (Name) ________________________ By __________________________________ Google Calendar □ Date and Initials ___________________ Comments:
Page 2 of 2
As of April 2016
Building Use Form This form must be filled out and returned to the Church Office no less than 2 weeks prior to your event. Groups that have requested a date and time AND have returned a Building Use Form will have priority. Name of Organization/Group ________________________________________________________________ Responsible Party _____________________________________ Phone_______________________________ Address __________________________________________________________________________________ Email ______________________________________ Preferred method of contact ____________________ Event Name and Description ________________________________________________________________ __________________________________________________________________________________________ Date(s) Requested ____________________________Start Time_____________ End Time______________ Purpose of event _____ Church Sponsored Event _____ Member Use _____ Community Organization/Non-profit _____ Other
_____ Non-Member
Frequency of event _____ One Time _____ Monthly _____Weekly _____ Multiple Days Room(s) Requested ____ Fellowship Hall
____ Kitchen
____ Lounge _____Sanctuary
____Education Wing
____ Reichley Room
____ Full Facility
____ Other ____________________________________
Anticipated Number of Participants _____________________ Will Participants be Charged a Fee _____Yes
_____ No
Will Food or Drink be Consumed _____ Yes
_____ No
Special Needs/Setup Instructions __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________
Page 1 of 2
As of April 2016
Building Use Form (Continued)
_____ I hereby acknowledge that I have read the Building Use Policies and guidelines for Christ United Methodist Church and I agree to abide by them. _____ I agree to comply with the guidelines for the use of Church Facilities and assume responsibility for following all the guidelines. _____ I understand that I am responsible to return the room(s) to the set up that I found it in. If there is damage or additional cleanup needed I understand additional fees could be assessed. _____ The person/organization requesting the use of Christ United Methodist Church facilities hereby absolves the church, its pastors, leadership, trustees, members, or people of any liability for personal injury to any individual resulting from the use of the church facilities and agrees to be responsible for any property damage that results during the use of the facilities. Please report any damage to the church office promptly at 215-855-1643
_______________________________________________________ Signature of Responsible Party
Date: ______________________
_______________________________________________________ Printed Name **If you are an organization or business please provide a certificate of insurance to the church office.** For Office Use Only Room Use Category ___________________________________________________________________________ Date Received ___________________
Fee ______________________
Date and Time of Event ____________________ No Conflict □ ___________ Fee Paid □ Amount Received, Date and Initials __________________________
□ Request Approved
□ Request Denied
Approved By _______________________________________
Notes _______________________________________________________________________________________ Applicant Notified □ (Name) ________________________ By __________________________________ Google Calendar □ Date and Initials ___________________ Comments:
Page 2 of 2
As of April 2016
