Building Use Application

Instructions; Please fill out this application and then print the page and return to Roxanne at rox252@comcast.net.
Remember that you must read the use of building form and then fill out this information, print the page and then email Roxanne or call her at (203) 757-0331. For a PDF version of the application, please follow this link. By filling out this form it does not indicate that the church will rent or let you use the hall and you will be given further information and verification for you.

Date of Application:		Name of Organization
Contact Name:		Type of Organization:
Address (1)		Address (2)
City:		State, Zip-Code
Purpose of Organization:		Type of Event
Is this event for a non-profit?		If yes, who will it benefit?
Any admission fees?		If yes, please state amounts;
Representative Contact Number		Contact Email Address:
Representative Address:		City, State, Zip-Code
Are you a member of this church;		Anticipated Attendance:	(approximate)
PROGRAM NEEDS:	DATES NEEDED: (Starting)	Enter end date;
Times: (Starting - Include Set-up)		End Time (Include Breakdown)
Frequency		If more than once enter dates:

Enter needs:	Chairs May charge for chairs over thirty.	Tables May charge for chairs over fifteen.	Microphones
Please Enter Other Needs such as Stage, TV, kitchen, podiums, screens, etc...		Please enter the rooms you are planning to use, such as main hall, kitchens, other rooms;
Use of Organ?		Director of Music Clearance;
Certificate of insurance?		Name of Insurance
Have you read the rules of use?		Have you contacted Roxanne?

You must print this application and submit via fax, email or in person. If you have any questions you should contact Roxanne. Once you print and submit this application it will constitute as if you had completed the actual application. Please read and print a copy of this form and rules of use for your records. I, the undersigned, agree to comply with the rules and regulations as stated in the form I have read and printed. We will only those rooms assigned, and following the directions given by the Church Building Agent on duty. In addition you must provide proof of insurance through a certificate of insurance. Additionally your event might require a Sexton to be on duty.