Activity Clearance From

Requests must be submitted at least two weeks prior to the proposed date of the activity. No publicity can be released until final approval of an activity. Return this completed form to the Administrative Assistant for Ministries at the Church office. Forms will be processed and the ministry representative contacted within 2-3 working days.

Activity Description
Date(s) Requested
Beginning Time Beginning Time : HH MM AM/PM
Ending Time Ending Time : HH MM AM/PM
Frequency of Need
Several Days

Several Days Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Room/Area Requested
Estimated Attendance
Will any food or drink be served?

Will any food or drink be served? Yes No
Special Equipment Requested
Ministry Name
Ministry Representative Ministry Representative First Last
Phone Phone - ### - ### ####
Email
Date Date / MM / DD YYYY
Draw your signature into the box below.

Draw or Type

I accept full responsibility for the facility and equipment requested above during the period in which the above Ministry will be using said items. Any damages or malfunctions will be reported immediately. Clear

Full Name

I accept full responsibility for the facility and equipment requested above during the period in which the above Ministry will be using said items. Any damages or malfunctions will be reported immediately.