Building Usage Request Form

Date of Request: _____________________ Date of Event: ____________________
Time of Event: From ____________________ To: _______________________________
(Include setup and cleanup time)
Purpose of Event:

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Special Arrangements:

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By signing below, you are indicating you have read and agree to abide by the General Policy for Use of FBC Buildings & Grounds.
Event Host: ________________________________
Signature: _____________________________ Name (Printed): _____________________________
Address: _____________________________________________________
Phone Number(s): ________________________________
Office Use Only
Approved by Board of Trustees:
Signature: _____________________________ Name (Printed): ________________________
Custodian: _____________________________ Yes No Fee: ________________
Custodian: _____________________________ Yes No Fee: ________________