Epworth United Methodist Church
APPLICATION FOR USE OF CHURCH FACILITIES
Name of Organization or Person Requesting Space:
_____________________________________________________________________________________________
Address______________________________________________________________________________________
State _______
Zip__________ Phone#______________________ Email__________________________________
Purpose of Event __________________________________________________________________________________
Day ________________________
Alternate Day________________________
Time of Event __________________________
Number of people Expected___________
Please give a brief description of people in attendance (age, any disabilities, etc.) _____________________________
_______________________________________________________________________________________________
Do you have insurance?________
You may requested to supply a certificate of insurance
Name of Insurance Company: __________________________________Policy #_________________________
Do you have a Safe Sanctuary Policy? ______ If not, you will receive our policy to which you are responsible to follow
SPACE REQUESTED
1. Fellowship Hall
____
4. Other ( meeting room, stage, etc)
2. Gym ____
3. Main Kitchen _____
_________________________________________________
Will you need tables and chairs? ______ How many? _______
Will a donation be offered to the church? _________ if yes, Amount to be offered __________________
(Suggested donation is $100 per space and a $50 deposit that will be returned if space is left clean & proper)
I accept responsibility for the condition of the space requested and any damage done by the above mentioned
organization or group. I understand if any damage does occur, I (responsible party) will be financially responsible for
its repair or replacement. We have read and accept the church use policy on the back of this page.
Signature of Responsible Party or Representative ____________________________________Date _______________
Name ______________________________________________ Phone ________________________________
-----------------------------------DO NOT WRITE BELOW THIS LINE - OFFICE USE ONLY-------------------------------------------------Is date & space available? Y
N
Approved__________ Denied__________
Signature Board of Trustee President ___________________________________Date
Date Received
___________ Date Returned
_______________
_______________
Rules and Conditions for Use of Church Facilities
1. It is the responsibility of all persons who use the property, buildings and utilities of the church to treat all
possessions of the church with utmost respect and reverence.
2. NO DRUGS OR ALCHOLHOLIC BEVERAGES ALLOWED ON PREMISES.
3. NO SMOKING allowed inside the building.
4. No event will start before 8AM nor run beyond 10PM. Any violation of this will result in loss of deposit.
5. A safe sanctuary policy is to be in affect at all times for those under 18 years.
6. Children should not be allowed to run around the building. Any damage will be the user’s responsibility, as
stated on the signed application.
7. All chairs, tables, furniture used must be put back in their original place.
8. All garbage must be tied and bagged and put in the trash cans outside. Your garbage must be picked up from
outside as well.
9. The hall, room and kitchen floors must be kept clean.
10. Check restrooms for cleanliness. Make sure all water faucets are turned off in the bathroom and kitchen areas.
11. PLEASE TURN OFF ALL LIGHTS AND FANS (including restrooms).
12. Windows must be closed and locked.
13. Heat and air conditioning is for needed hours only. Please remember to turn it back when leaving.
14. If kitchen is used, it shall be cleaned and put back in its original condition. Make sure all stove burners are off.
15. Nothing is to be removed from or to be left in the refrigerator.
16. Epworth is a Styrofoam free facility. Please refrain from using Styrofoam products.
17. User is not permitted to use church utensils, dishes, or coffee-making machines.
18. Only occupy the rooms that you have requested to use.