Building Use Request Form

Please Read Building Use Policy and Fill out the request form below.

Building Use Policy – Member Request

Building Use Policy – General Public

Building Use Policy – Non-profit request

Limestone Presbyterian Church
101 East Jefferies Street
Gaffney, SC 29340
Telephone: 864-489-6079
Fax: 864-489-
E-mail: limestonepresbyterian@bellsouth.net

APPLICATION FOR BUILDING USE

Organization Name:

Applicant’s Name, Address, and Telephone Number(s):

Email:

Purpose and/or Type of Meeting:

Date and Hours of Use (Include set-up and clean-up time):

Frequency of Meeting (Number of Times, Days of Week, Etc.)

What Room/Facility Are You Requesting:

Special Arrangements Requested (If you need equipment such as tables, chairs, podium, TV/VCR/DVD player, piano, etc., please state here).

Outside groups are expected to do their own set-up and clean-up, unless otherwise requested. If custodial services are requested, or if additional clean-up is needed after the activity, an additional fee of $15.00 per hour will be assessed. Arrangement for custodial services should be made with the church custodian prior to the activity.

Adult Supervisors (age 21 or over) for Youth Groups (Names, Addresses, Telephone Number(s):

WE THE APPLICANTS, AND DULY AUTHORIZED REPRESENTATIVES of requesting the use of Limestone Presbyterian Church facilities and/or property, have read all the provisions contained herein, and agree to fully comply. Further, we the undersigned, agree to relieve Limestone Presbyterian Church, its agents, and employees of all liability for acts committed by persons participating in this event, resulting in personal injury, sickness, disease, or death. I/We further agree that, in the event of damage by any invited or uninvited participant in this activity to church property, i/we accept full responsibility, and agree to pay for such damages in full. I/We further acknowledge reviewing and receiving copies of the following: 1.) Application for Building Use 2.) Responsibilies of Facilities Users and 3.) Checklist for Limestone Presbyterian Building Closing.

Electronic Signature(Type your name)

Electronic Signature

Date and Time:

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