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Sample Building Use Form

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Sample Building Use Form

For Non-_________________Use

Name: ____________________________ Phone: (H) _______________(W) _______________

Address: _______________________________________________________________________

Date Needed: __________________ Time: From _________________ to ________________

Reason for Building Use: _______________________________________________________

Number of People Expected: ____________________________________________________

Information below will be determined by the Building Superintendent who will contact inquirer.

Previously established Non-________ Wedding Fees are shown on the _________ Wedding Policies.

Mandatory Fees:

Deposit/Application Fee:


Janitorial Fee ($17/hour)


_____________ Representative ($17/hour)


Utility Fee ($6/hour)




Optional Fees:

Audio/Visual Assistant ($17/hour) (Auditorium Only)




Mandatory Fees


Optional Fees




**Due after approval and prior to use; balance due within five working days of date building used. Fees will be adjusted according to actual fees and times. Deposit refundable if no damage occurs.

Fees for Non-__________ May be Waived for the Following Reasons:

    1. By Elder approval

    2. If the activity meets approved ____________ usage guidelines and can be scheduled during times of normal ___________building use when space is available.

Applicant's Signature: ________________________________________ Date: ___________

Elder Approval/Disapproval: ___________________________________ Date: ___________

Related Topics: Administrative and Organization