Contact Person:

Daytime Phone Number: Number Attending:

Date of Use: Time of Use:

Monthly Weekly One-time Use

Nursery Needed: No Yes -additional cost for room and nursery worker.

I have read and understand the policies pertaining to the use of church facilities and agree to them. I also understand all fees (as outlined below) are payable in advance.

Signature Date (please type in your name for electronic signature)

Address City

State Zip Code

************************************************************************************************************

Please check the rooms you would like to reserve.

Gym $30/hour ($15/hour for recurring events)

Parish Hall $30/hour ($20/hour for recurring events)