Facility Request Form
Upon completion, this form must be submitted to Member Services at the LaHaye Student Union. Fees will be
determined upon completion of this form at the discretion of the Campus Recreation Department. Requests must
be submitted at least two weeks prior to the date requested. Completing this form does not guarantee use of the
facilities. For more information please contact the LaHaye Student Union at (434) 592-3221.
Date(s) Requested: ______________________________________________________________
Affiliation to Liberty University:
Staff/Faculty
Student
Other
Facility Requested:
LaHaye Rec and Fitness Center:
Multipurpose Room
LaHaye Court(s) _____
Rock Wall
Indoor Pool-Lane(s) _____
Soccer Field(s) ______
Camp Hydaway:
David’s Place:
Pavilion
Theatre
Campsite(s) _______
David’s Place Common Area
Student Center Kitchen
Student Center Multipurpose Room
Bonfire Area
Group / Organization: _____________________________ Times: ____________________________________
Description of Event / Movie Title: ________________________________ # of Persons Attending: _________
Set-up Needs: _______________________________________________________________________________
____________________________________________________________________________________________________
The above organization agrees to (1) safeguard the facility and its furnishings, (2) return the facility to its original setting
following the event, and (3) dispose of trash properly. Furthermore, the organization agrees to reimburse Liberty University
for maintenance or housekeeping costs resulting from misuse of or damage to the facility.
Requestor (PRINT): ________________________________ Phone: _____________________________
Address: ________________________________________ Cell: _______________________________
City, State, Zip: __________________________________ Email: _____________________________
Signature: _______________________________________ Date: ______________________________
For Office Use Only: Manager’s Initials: _______
Amount Due: __________
Today’s Date: ____________
Date Paid: __________
Approval Signature: _________________________________
Time: ___________
Work Order #: _____________
Date: ___________________________