Name/OrganizationToday's Date MM slash DD slash YYYY Contact PersonAddress Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone NumberEmail Address Church Status Active HBC Member All Other Individuals HBC Member SponsorFacilities to be Used (check all that apply) Sanctuary Classrooms Nursery Dressing Rooms Fellowship Hall Family Life Center Kitchen Date(s) Requested: From MM slash DD slash YYYY To MM slash DD slash YYYY Time of EventNumber of Participants Expected at EventSet-up Time for Event (doors will be opened at this time - key?)Special Requirement Needs Tables Chairs TV/Video Sound System Sports Equipment Other (please explain below) OtherThe individual/organization is responsible for any damage to the building and/or equipment during the activity. The church custodian or his designee will inspect all facilities and equipment used to be sure that they are in good condition without damage.The individual/organization is responsible for replacing all tables and chairs to their original positions, and storing all equipment in proper areas.The individual/organization is responsible for any security needed for the building and church grounds during the event.Consent I have read, reviewed and agree to follow all of the HBC Facility Policies.Name First Last NameThis field is for validation purposes and should be left unchanged. Δ
