Building and/or Equipment Usage

Please complete this form to reserve our facility.

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Contact Information
Name of Requesting Group/Individual:
Contact Name: Contact Name: First Last
Contact Address: Contact Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact's Phone: Contact's Phone: - ### - ### ####
Contact's Email:
Facility Reservations

Complete the information below for member and non-member private activity.
Name of Event:
Event Date: Event Date: / MM / DD YYYY
Active Fob Times
Door will unlock at: Active Fob Times
Door will unlock at: : HH MM AM/PM
Door will lock at: Door will lock at: : HH MM AM/PM
Door Accessed:

Door Accessed: Front Door Playground Day Care Kitchen
Are you a member of Zion:
Is Building/Equipment for Private Use?
Security Deposit needed upon facilities reserved:

Security Deposit needed upon facilities reserved: Non- Member Security Deposit - $150.00 Member Security Deposit - $100.00
Non-Member Fees:

Non-Member Fees: Dining Room & Kitchen - $150.00 Gym - $60.00 Gym/Stage - $110.00 Library - $35.00 Supervisory Person - $50.00
Member Fees:

Member Fees: Dining Room & Kitchen - $100.00 Gym - $40.00 Gym/Stage - $75.00 Library - $25.00 Supervisory Person - $50.00
Please list extra equipment needed; such as: tables, chairs, audio-visual, piano, podium, gym equipment, etc.
I accept responsibility for the restitution for necessary cleanup and/or damages to the facilities and/or equipment.

I accept responsibility for the restitution for necessary cleanup and/or damages to the facilities and/or equipment. Yes
Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date signed: Date signed: / MM / DD YYYY
$0

Total

Building and/or Equipment Usage

Building and/or Equipment Usage

Contact Information

Facility Reservations

$0

Total

$`0`