CENTRAL PRESBYTERIAN CHURCH

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Facility Request Form

Email *

Fully Complete

The CPC staff will process the application form and upon approval of the request, will schedule the activity.
CPC will contact you to advise of status (approved/not) of your request. An estimated usage fee will also be given.

Contact Information:

List the person who will oversee the event.

Name *

Organization (if applicable)

Phone (List 2) (Home, work, cell) *

Email *

Use Status *

CPC Member, Private Use

Non-profit organization, associated with CPC Member (compatible to CPC philosphy)

Non-profit organization, NOT associated with a CPC member (compatible to CPC philosophy)

Required

Purpose of Event (required): Please be specific *

Date of event *

YYYY

Number of people expected to attend

Event times (Please include Arrival (set-up) time, Event Start time, Event End time, and Departure (AFTER Clean-Up) *

FACILITY NEEDS: Mark which room(s) that you are requesting *

Sanctuary (no food or drink)

Friendship Hall (up to 250 people banquet or 350 people theater seating)

New Life Center (2nd floor)

Parlor

Classroom

Required

If you selected Classroom, please specify:

Kitchen *Kitchen equipment requires a trained coordinator approved by CPC.

Kitchen - Limited Use- No Cooking

Kitchen - Cooking and/or Food Prep

Caterer will be using Kitchen

N/A

Clear selection

If using caterer please list company and phone #

GENERAL: Select one: *

We are committed to cleaning the facility after our event, which includes bathrooms, sweep and wet mop floors and empty trash cans (the dumpster is located outside at the rear of the building).

We would like the church custodian to clean the facility after our event (fee applies).

EQUIPMENT NEEDS: Mark all requested:

Oblong Tables Needed

Round Tables Needed

Chairs Needed

N/A

Clear selection

How many of each do you need?

If you selected Tables/Chairs, please indicate SET-UP:

We will set-up

Please have custodian set up for us (fee applies)

Please also indicate TEAR-DOWN:

We will return the room to its original set-up

Please have custodian tear down for us (fee applies)

Other

White Board

Lectern

Music Stand(s)

Easel

Piano

Stage

Microphone

Other, please specify below

N/A

Clear selection

If you selected Other, please specify

TECHNOLOGY SUPPORT (trained CPC staff fee applies)

Microphone(s), Sound System, Video Projection: Describe your needs and any special requests:

LIABILITY & FACILITY REQUEST AGREEMENT

I have read the CPC Facility Use Policies & Fees document for use of this facility, and I agree to abide by it if granted use. *

Yes

Required

Initials: *

Organizational users are required required to have a minimum liability occurrence limit of $1,000,000 and must provide CPC with a certificate of insurance seven days prior to date as outlined in Facilities Use Agreement if granted use of CPC. Please provide name of insurance carrier:

Member users are required to take full responsibility for their group, any injuries that may occur and pay for any damages to the CPC facility if granted use of CPC.

Yes

Member users initials:

* Note: CPC activities supersede use of the building over outside organizations.

By signing your name to the facilities request form, you assume ALL responsibility for all damage(s) to the facility and equipment during the scheduled event if approved. You also assume responsibility for enforcing code of conduct as outlined in the CPC Facility Use Policies & Fees document.

Signature of Responsible Party: *

Today's Date: *

YYYY

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms