First Christian Church
(Disciples of Christ)
REQUEST FOR USE 3109 Rivermont Avenue
Lynchburg VA 24503
OF CHURCH FACILITIES Phone: 434-384-8626
Fax: 434-384-2861
Email: office@feclynchburg.org
Name of Organization: Vireinian 2 Lov Alternat. tte. Death Leadty
Date of Req — thal oy 22/)_ Dateof Use:_ Ay 4, 20/2 (
Access Time: From 40 amon) To & HO (amp
O Fellowship Hall Kitchen O Nursery O 3rdFloor O Classrooms O Sanctuary
QO Parking Lot Parlor O Other:
Contact Name(s): Mitee! Some
Address: _£U. ox 2I2 9. City: Kichmon, Zip: Z324y
Phone: Work 4. G 79 _ Ext. Home: Cel: ZY-GI— 277%
Email: Sice@ Vedpe ory Are you a non-profit group? Yes ) No
How many in group: (5 /pJ Purpose of group? dea earthy abo Ga
(
Are you a member of this church? Yes 4 No.
If No, how did you learn of our church? __ Clhsz/) Dox: execution viele
Fee to be paid: $ 272" $75.00 per day for use of Fellowship Hall & KitchenU
See reverse side for other fees.
The above Organization and Contact(s) agrees to abide by the “Policies and Procedures for Use of Church
Property” (on back page) and to be responsible for any and all damage to the church building, grounds, or
other church facilities resulting from their use. Children and youth will be chaperoned at all times and all per-
sons will remain in the areas of the church authorized by this approval. The person signing this original re-
quest form is responsible for the condition and security of the building and will be required to correct any deficien-
cies or forfeit the security deposit.
< Late > Nickee! £. Done
(Signature of Person in Charge/Contact) (Printed Name)
Fellowship Hall/Kitchen Security Deposit $100 (to be returned upon inspection of facilities used).
Security Deposit is $25 for all other areas of church use.
Deposit paid by__cash___check# _____
Key checked out to:
Date Key returned : / / Date Deposit Returned: / /
Office Use Only
Date Approved: Date Denied: Date Check Received:
Special Instructions:
Authorized Signature: Title:
Revised 2-22-2010
v
ecause we strive to be faithful to serving Jesus Christ, First Christian Church is committed to the ministry of hospitality.
One of our essential affirmations of belief is that we are called to “welcome as God welcomes.” It is in this spirit that we
are pleased to offer the building for your use. In an effort to maintain good communication with the groups who use the
building, we are making the following requests.
PROCEDURES FOR USE OF CHURCH PROPERTY
The church building may be used by any person or group that intends a use that is consistent with the mission and values of
First Christian Church. All organizations or individuals wishing to use the church property shall submit a completed request
form to the church office for consideration a minimum of ten days before the event. The request will be acted upon within
seven days.
Fees:
e Fellowship Hall & Kitchen - $75 per day Classroom use fees - $15 each classroom
e Parlor and Warren Fellowship classroom - $25 Weddings - please request Guidelines and Fee Sheet
© Parking lot use - $25 Overnight events - $25 per day.
In addition a $100 security deposit is required. If damages occur or extra cleaning is necessary, a portion of the security
deposit (at the church’s discretion) may be used for repair or clean-up. If the church areas used are in good condition, the
entire security deposit will be returned. Required fees shall be paid to the church office at least five days prior to the event.
Depending on the use, members of the congregation and those organizations that are supported by the Outreach Department of
First Christian Church may have fees waived. Because the church is used by many groups, often desiring the same space, users
should notify the church office if they are unable to use the building at the agreed upon time. Unless prepayment has been
provided for an event, twenty four hour cancellation notice must be given in order to avoid being a assessed a “Failure to
Show” fee which is $20. Payment will be required before the group is allowed to use the building again.
If the event is at a time other than during regular office hours, the user will make arrangements with the church office regarding
picking up a key to open and close the church. Users who are not members of FCC will be charged a refundable security
deposit. The key should be returned after the function as soon as possible, and the deposit will be refunded once the facilities
used are inspected. PLEASE NOTE: The heat thermostat in the Fellowship Hall must be set back to 55 degrees after using the
facility. The cooling thermostat must be set up to 80 degrees. Failure to do so will resort in the loss of the security
deposit.
Users shall be responsible for and make all arrangements for setting up and taking down tables, chairs and equipment.
Approval is needed from the office in advance before equipment can be moved from one room to another.
Users serving meals or refreshments shall provide their own food and supplies unless otherwise approved. PLEASE NOTE:
Because of severe food allergies, we ask that you bring no nuts or nut products in to the church.
The user shall provide adequate adult chaperones whenever there are youth activities or whenever users bring children into the
church. The chaperones shall ensure control of the children/youth at all times and keep restricted to a specified area. Children
are never to be left un-chaperoned inside or outside of the church. All users shall restrict their activities to those areas approved
in the agreement including adjacent rest rooms.
First Christian Church is a smoke-free, alcohol-free building.
Users shall be responsible for restoring areas used to the original condition prior to their use, including but not limited to
sweeping floors and straightening/cleaning restrooms used. Users will deposit their trash bags marked with a trash removal
label (available from the grocery store) into the furnace room (lower floor, door at bottom of steps). Users shall further be re-
sponsible for seeing that all windows are closed and locked in the area used; that lights, air conditioning and heat are turned
off; and that all exterior doors are securely locked when departing the building. The person signing the original request is
responsible for the condition and security of the building, and may be required to correct any deficiencies - see signature page).
Outside groups that wish to stay overnight on the third floor of the church must meet the following criteria:
We can accommodate groups up to 25 people. This limit is due to fire code regulations and the fact
that we only have two showers.
Groups may use the 3rd floor kitchen or the main kitchen downstairs (giving priority to other
groups using the downstairs fellowship hall and kitchen).
Groups should bring their own food and supplies, paper products, etc. Groups should not
use the churches paper products, coffee, sugar, creamer, etc.
Groups should bring their own sleeping bags, pillows, towels, shower shoes, and toiletries.
Shelves with hooks for toiletries and wet towels are provided in each bathroom.
Groups are expected to keep the areas used neat during their stay. Clean-up is expected before the group leaves to go home.
Someone from the church will check the areas used before the security deposit (or a portion thereof) is refunded.
Ihave read, understand and agree to abide by the policies and procedures listed on both sides of this form:
LM LGD Vit Lede.)
Signature Organization Date
CC BY-NC-SA 4.0