KUMC Building and Grounds Request Form

Complete this form to submit your request. If a section does not affect your function, skip that section.

Please keep in mind that this request must be approved by the program director of your area.

IT IS IMPORTANT THAT YOU UNDERSTAND THAT BY SUBMITTING THIS FORM YOU ARE AGREEING TO ABIDE BY THE RULES SET FORTH IN THE POLICIES OF KILLEARN UNITED METHODIST CHURCH.

GENERAL INFORMATION
Name:
Organization:
Home Phone:
Work Phone:
Cell Phone:
E-Mail:
Date of activity, starting:
Date of activity, ending:
Occurrence:
Date of Request:
Start Time:
End Time:
Setup Time:
Type of Meeting:
Size of Group:
BUILDING/GROUNDS RESERVATION
Room Preference?
Restroom Facilities Needed? (Grounds Use Only)	Yes No
Having Refreshments?	Yes No
If you require the following items, please indicate the number needed:
	Tables
	Chairs
	Tablecloths, Round
	Tablecloths, Rectangular
	Appliances, Stove
	Appliances, Refrigerator
	Appliances, Freezer
Comments:
Is a meal being prepared in the kitchen or is this a catered or covered dish affair?
NURSERY REQUEST
IMPORTANT: Nursery requests must be turned in 3 weeks prior to event. Nursery will only be scheduled if reservations are received. Otherwise Nursery is not scheduled.
Regularly scheduled nursery times are as follows:
	Sun. Mornings, 9AM-12PM
	Mon. Evenings, 6:30pM-8:45PM
	Tue. Evenings, 6:30pM-8:45PM
	Wed. Evenings, 6:30pM-8:45PM
If Yes, please indicate by selecting the checkbox next to the desired time above.
If your event requires nursery outside the times listed above, please indicate the dates and start and end times:
IMPORTANT: Requests for nursery outside the regularly scheduled hours require approval from a program director as well as the account number to be charged.
MEDIA RESOURCES NEEDED
	Media Technical Staff Required
Name:
	How Many Wired Microphones?
	How Many Wireless Microphones?
	Pulpit/Lectern Microphone
	How Many Direct Inputs?
	Direct Boxes Need To Be Provided
Additional Notes:
	CD Playback
	Keyboard
	Piano
	Drums
Other:
VIDEO RESOURCES NEEDED
	Video Projector
	DVD Playback
	VCR Playback
	Powerpoint/MediaShout
PowerPoint/MediaShout presentations must be on a CD and coordinated with tech. staff in advance of the event.
	Computer
PC/Apple Compatible?
IMPORTANT: Competing this form does not guarantee equipment availability. Depending on the number and type of concurrent events, requested equipment may not be available in all rooms. Check availability prior to submitting request. This form assumes usual set-ups unless otherwise specified.
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