Name of Organisation

Name of Person submitting the request

Telephone Number

Proposed Event

Date and Time of Proposed Event

Accommodation Required, tick all rooms that are required:

Conference Room
Meeting Room
Praise Room
Committee Room
Welcome Area
Kitchen
New Hall
Major Hall
Intermediate Hall
Minor Hall

Equipment Required, tick all equipment that is required:

Sound
Computer
Screen
Flip Chart
Data Projector
Other equipment

Please ensure that the following questions are answered fully.

Have you approached any other organisation that may be using these facilities? Please state the person and organisation approached.

Can you confirm that the other organisation has confirmed that you CAN use these facilities?

For youth/children's events

Can you confirm that you have arranged for adequate ADULT supervision to comply with Child Protection Guidelines?

Number of adult supervisors

Number of children expected

Have you read and understood the Child Protection Guidelines?

Who has been designated as the person who will secure premises after the event? Please state name and telephone number

The date of the application will be taken as the date this form is received by the Church Office.