Building and Grounds Use Agreement

Date

Name of Organization

Organization's Purpose

Non-Profit Status (if applicable)

Federal ID No.

Insurance Carrier

Responsible Person

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Event Name and Description

Date(s) Requested*

*Dates can only be scheduled more than months out by special permission.

Start Time

End Time

Event Recurrence:

Which day(s) of the week?

Room(s) Requested:

Anticipated number of participants:

Will participants be charged a fee?

Will food, drink, or alcohol be served?

Special needs or requests (piano, sound system, other)

Set Up Instructions

I have:

Name *

First

Last