Name of Responsible Party *

First Name

Last Name

Phone *

(###)

###

####

Requested Date of Usage *

If requesting for multiple days, input first day here and indicate the date range in the description above

MM

DD

YYYY

Beginning Time of Event *

Not including setup

Hour

Minute

Second

AM PM

End Time of Event *

Not including cleanup

Hour

Minute

Second

AM PM

I have read and agreed to theRefuge Church's Building Policy (**link below): *

I agree