Facility Rental Form

Fluvanna Community Church
Facility Rental Request Form

First Name

Last Name

Organization

Requester Type

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Phone Number

Email

Facility Space Requested

Event Start Date

Event Start Time

Event End Date

Event End Time

Event Description

Checking the acknowledge box below, you acknowledge have read and understood the attached Facilities Use Policy of Fluvanna Community Church and agree to abide by all of the regulations and provisions set forth in the policy.

Signature

Fluvanna Community ChurchFacility Rental Request Form

Fluvanna Community Church
Facility Rental Request Form