Facility Use Request

FACILITY USE REQUEST

St. Andrew’s Episcopal Church P.O. Box 8 1062 Chet Smith Ave. Derby, KS  67037 316.788.2595 Email:  standrewsderby@gmail.com

Today’s Date:_______________________

Requestor’s Name:_____________________________________________________________________

Address:______________________________________________________________________________

Phone:_______________________________________E-mail:___________________________________

Event (please include description)

How many tables and chairs?__________________________

Will the kitchen be used and to what extent?______________________________________________

Will food be served?___________ Will alcohol be served? _______If so, you must offer other attractive non-alcohol drinks.

Other requests:________________________________________________________________________

_____________________________________________________________________________________

Requestor:_____________________________________________   Date:_________________________

Approved:______________________________________________   Date:_________________________

——————————————————————————————-(For Parish use only)

Fee for event____________ Paid by (check or money order)_____________ Date paid_________

Team member_______________________

Check in time________________________                        Check out time _______________________

Description)_________________________________________________________

Date:_______________________________Begin time(including time for set up):_________________

End time (including time for clean up):____________________________________________________ How many will attend?___________________