Building Use Request

BUILDING USE REQUEST FORM

Clifton Park Baptist Church
8818 Piney Branch Road
Silver Spring, MD 20903
Office: 301-434-2456 Fax: 301-434-4114

Date Submitted:

Organization/Name of Requestor: *

CPBC Member: *

yes no

Address: *

City & State: *

Zip:

Phone Number *

Area Code Phone Number

E-mail *

Type of Function:

Expected # Attendees:

Event Date(s):

Time Desired:

(Include set up / clean up time)

Areas Desired: *

Sanctuary Gym Fellowship Hall Social Hall Classrooms Youth Room Kitchen Other

Will you need to have the stove/oven lit for you?

No Yes

Will you need a Trustee to let you into the building?

No Yes

SET UP AND CLEAN UP IS THE SOLE RESPONSIBILITY OF THE PERSON(S) REQUESTING USE OF THE CPBC FACILITY.