Facility Use Request Form

Name of Person/Organization:

Person Responsible

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Event, Date/Time, # attending:

Set-up Date/Time:

Breakdown Date/Time:

Include part(s) of facility needed

Multi-purpose Room

Grand Hall

Kitchen

Nursery

Classrooms

If you want to rent any classrooms, which ones?

(Room 1, 2, 3, 4, 6, 8, 9, 10, 12)

Additional information or special arrangements needed:

Is this a fundraising event?

Note: Approval by the CCC Elders is required for all fundraising events.

Yes

Once you send this form to us, we will get back to you with a fee estimate. All fees are due one week prior to the event date.

Saturday Weddings: The ceremony must start no later than 1:00 p.m. (no exceptions). The MP Room, including the stage area, must be cleared by 4:00 p.m. No alcohol allowed on the church premises.

As representative of the event, I acknowledge my responsibility to ensure that the CCC facility is left in the condition in which it was found. I understand that this includes: clean-up; return of furniture and equipment to its original configuration; responsibility for any damage to facility, equipment, or furnishings; and properly securing the building. Adequate childcare must be provided. No unsupervised children are to be in the building or on the grounds at any time.

I/We understand and agree that neither the Church, nor its trustees, representatives, employees, and agents may be held liable in any way for an occurrence in connection with the Activity which may result in injury, harm, or other damages to the undersigned or members of our organization and guests, invited or not. Rather, I/We agree that our Organization alone shall be responsible for any property damage, personal injury or death that may occur during our use of the premises. As part of the consideration for being allowed to use your facility, building and grounds as well as all appliances and fixtures in the activity, I/we release the Church, its trustees, employees, agents, or representatives from any claim for damages, injury or death which may occur while participating in the Activity. I/We further agree to save and hold harmless the Church, its trustees, employees, agents, or representatives from any claim arising out of participation in the Activity. I/We further state the I/we are authorized to sign this agreement; that I/we understand the terms herein are contractual and not mere recital; and that I/we have signed this document of my/our own free act and volition. I/We further state and acknowledge that I/we have fully informed ourselves of the content of this affirmation and release by reading it before I/we signed it.

If this is for an organization, please write the organization's name and the name/title of the Representative.

By entering your name here, you are agreeing to the above Hold Harmless Statement