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Facility Use Form
Name of Group or Event:
*
Date of event:
*
Date Format: MM slash DD slash YYYY
Are you a member of Innovation Church?
*
Yes
No
Group Affiliation:
Church Sponsored
School
Non-Profit (501c)
Charitable Fraternal
DESCRIPTION OF YOUR EVENT:
*
Estimated Attendance:
*
1 - 20
21 - 50
51 - 100
101 - 150
151 - 200
200 or more
Beginning time (include set-up)
*
:
HH
MM
AM
PM
Ending time (include set-up)
*
:
HH
MM
AM
PM
AREAS REQUESTED & DEPOSIT (check all that apply):
*
$50 Damage Deposit (required) REFUNDED IF NO DAMAGES
$100 Lobby
$300 Auditorium
Kitchen (Available with Lobby)
$25 Parking Lot (Only if event is here - otherwise free)
$25 Field (Only if event is here - otherwise free)
PRIMARY CONTACT PERSON
*
First
Last
Phone
*
Special Needs: (Setup, audio, video, lighting etc)
PLEASE CHECK ALL THAT APPLY:
*
$75 Set up fee (Required If Applicable)
$25 Cleaning fee (Required If Applicable)
$25 Sound Tech Weddings (Required If Applicable)
$25 Event Coordinator Weddings (Required If Applicable)
6 ft tables (if applicable)($25 deposit refunded if no damages occur) $5 each. NUMBER NEEDED? / TOTAL PRICE OF TABLES
White plastic chairs (if applicable)($25 deposit refunded if no damages occur) $1.50 each NUMBER NEEDED? / TOTAL PRICE OF CHAIRS
White polyester table clothes- (if applicable)($25 deposit refunded if no damages occur) $5 each NUMBER NEEDED? / TOTAL PRICE OF TABLE CLOTHES
Black polyester table clothes- (if applicable)($25 deposit refunded if no damages occur) $5 each NUMBER NEEDED? / TOTAL PRICE OF TABLE CLOTHES
FOR OFFICE USE ONLY:
TOTAL COST DUE:
*
25% Deposit amount due 3 days from time of booking:
*
Amount due one month from date of event:
*
Date Due:
Date Format: MM slash DD slash YYYY
Received By:
First
Last
Check Number
Certificate of Insurance
Yes
Waiver of Liability
Consent
*
I have read the facility use policies and I agree to the stated terms, conditions and policies. I understand that a $50 damage deposit and a 25% deposit is due at time of reservation and the additional balance is due one month prior to event.
Renter Signature:
Date:
Event Coordinator Signature:
Date:
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