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?___________________