ACTIVITY/ VEHICLE REQUEST FORM

Contact Information
Name *
Name
Address *
Address
Phone *
Phone
Background Policy *
I understand that it is my responsibility to make sure that my chaparones/leaders have completed their background check if the activity involves minors
Medical Waiver Policy *
I understand that it is my responsibility to have permission slips or medical waiver release of liability for all persons under the age of 18
On-Site Activity Request
Date
Date
Time of Event
Time of Event
End of Event
End of Event
Set up Time
Set up Time
Clean up & finish time
Clean up & finish time
List items needed for your event: (fire pit, chairs, tables etc)
Vehicle Request
Date vehicle is needed
Date vehicle is needed
Start time
Start time
Return time
Return time
Name(s) of Driver(s)
Name(s) of Driver(s)
Is the driver already on church insurance?
Off-Site Activity Request
Date
Date
Time of Event
Time of Event

*Trash must be removed from the building and placed in provided dumpster*

To arrange for building access call the office at 330-225-4366.
(All activities must be complete (including cleaning) before 10:59pm as the alarm will be automactically set)