Facility Request Form

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Name of Organization *
Person in charge of Activity * First Last
Email
Telephone * - (###) - ### ####
Mailing Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Nature and Purpose of Activity *
Number of people expected?
One-time request * Yes No
Please specify DATE, START TIME and TOTAL TIME for activity. TOTAL TIME includes total time needed for the activity, including time to set up and take down tables/chairs, etc. If this is a request for a series of activities, please specify and attach a list of all DATE(S) and TIME(S). / MM / DD YYYY
Start Time * : HH MM AM/PM
Total Time in Hours and minutes:
Buildings needed Sancutary Fellowship Hall Nursery Education
If Education or Fellowship Hall, specify which rooms and whether kitchen needed:
Tables and chairs needed (specify location if using more than one building/room):
Who will pick up key?
Date / MM / DD YYYY
Time : HH MM AM/PM
Who will return key?
Date / MM / DD YYYY
Time : HH MM AM/PM
Conditions of Use:
• MDLC invites use of its facilities by community groups and many groups use the facilities. Accordingly, all users must cooperate to ensure that the premises are shared and used respectfully. Use is a privilege, not a right, and permission for such use may be withdrawn if MDLC determines, in its sole discretion, that continued use by a group poses any safety or other concern, presents a risk of property damage, or is not consistent with the primary use of the facilities as a church and place of worship.
• Respect must be shown and cooperation given at all times to MDLC staff, MDLC members and other users of the facilities.
• No monies or fees are required for using our facilities that imply any business transactions, due to City of Bunker Hill laws.
Free-will offerings are accepted to defray utility costs, building maintenance and other operating expenses (estimated to be $60/hour).
• If usage includes any special set-up by our janitorial services for which fees are charged, or special clean-up is required by use, these additional costs will be passed along to the requesting group for reimbursement. Additional janitorial fee will be charged for use on holidays.
• Groups are required to leave facilities in similar condition to that found upon arrival (kitchen and coffee pots cleaned, tables wiped, tables and chairs returned to where found, restrooms tidy, trash cans emptied and returned to where found, etc.). If facilities are damaged, MDLC reserves the right to require you to pay for repairs or replacement or reimburse MDLC for same. Kitchen paper products will be furnished by your group.
• Participants must enter and exit parking lot as specified by signs for their own safety. Entrance and exit are one-way only.
• Participants are to be informed of exact location of activity so as not to disturb others who are meeting at the time.
• You must submit a new Facility Request for any changes as to building or rooms reserved, date, time or purpose of activity. Access to MDLC facilities is restricted to the dates, times and premises reserved by a group pursuant to an approved facility request.
• MDLC is not responsible for accidents, losses, or damages which may occur to persons or property involved/associated with your group.
• Permission may be modified or withdrawn if there is a funeral or other special service which requires the use of the requested space.
• If your group finds the premises have not been left in good condition by a previous user, please promptly report this to the MDLC office secretary.

Signature
Organization's website:
May we have permission to share your website on MDLC's website? Yes No
Date / MM / DD YYYY