Rental Use Request

Group Name *

Contact Name *

First

Last

Email *

Contact Phone Number *

Invoice Address *

Event Name

Event Purpose *

Space Requested

Event Date *

Event Time *

*Please include set up and take down time in your request*

Single or recurring rental? *

Additional Information

Number of people expected to attend the event?

Will any children or vulnerable adults be attending? *

Any furniture/equipment required?

Please write the type of furniture and the number needed. ie: chairs, tables, piano, audio/visual system

Will you provide your own equipment?

Will food be served? *

If Yes, Please Specify

Will coffee/tea/beverages be served? *

If Yes, Please Specify

Does your group have liability insurance? *

Registered Charity Non Profit Number:

Form Completed By: