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La Plata united methodist churchApplication for Use of FacilitiesGroup Name: ______________________________________________________________________________Event Title: ______________________________________________________________________________Primary Contact: _____________________________________ Phone: _____ _______________________Email: _______________________________________ Cell Phone: ________________________________Are you an active member of this church, and attend regularly? [ ] Yes [ ] No Secondary Contact: _____________________________Phone:___________________________________Email: _______________________________________ Cell Phone: ________________________________Is this person an active Member of this Church, and attend regularly? [ ] Yes [ ] No---------------------------------------------------------------------------------------------------------------------------------------Meeting Schedule: [ ] One time only[ ] Weekly [ ] Bi-Weekly [ ] Monthly [ ] otherDate(s) requested _________________________ Alternate Date(s) ___________________________Beginning Date ___________________________ Ending Date ______________________________Set Up Time: _____________________________Clean-up / Reset Finish Time: _______________Event Time _____________________________Event Ending ______________________________Space Requested:[ ] Sanctuary[ ] Fellowship Hall 1[ ] OTHER _________________________[ ] Room 106 (Old CR1)[ ] Room 104 (Old YR)[ ] Kitchen with light snacks, no cooking [ ] Room 110 (Old CR2)[ ] Kitchen with on-site food preparation (active members only)Do you or someone in your group have a key to the building? [ ] Yes [ ] NoType of Activity_________________________________________________________________________Will food or beverages be served? [ ] Yes [ ] No** Please note that there is NO Food or Beverages are allowed in the Sanctuary Number of people attending ____________ Number of Chairs/tables needed _____________Please submit a diagram or instructions for Table & Chair set up. (Nonmembers only)In submitting this application, I hereby state: I am familiar with the policy/procedure for the use of the space adopted by La Plata United Methodist Church. I agree that we shall not hold the church responsible or liable for any accident which may occur. Furthermore, we will check with our insurer and name the church as additional insurer on our policy. Signature _________________________________________Date ______________________________________Church Approval Signature _______________________________ Approved Date _________________________Total Fees $___________ Paid Date ___________ Check number __________ Received by ________________Phone(301) 934-2288Fax(301) 934-5791E-maillaplataumc@Web site Port Tobacco RdP.O. Box 2824La Plata, MD, 206467620092710Version 05.17The fee schedule is as follows: For non-members and inactive members - $500For church sponsored groups - $200For active church members - $125These rates are for the fellowship hall. Rates for the Sanctuary, classrooms and kitchen vary based on the activity and length of rental.These rates include our Church Sexton fee for church cleaning after use. A $100 deposit for non-members is required at the time of signing this application and the balance must be paid one week prior to your event.A $50 deposit for members is required at the time of signing this application and the balance must be paid one week prior to your event.In the event of an emergency, please contact the Trustee Chair, Kevin Robbins at 240-682-2348 or 301-392-0218 or the Building Superintendent, Ed McKenzie at 240-210-1908 or 301-934-9517. Contract terms and conditions:Applicant must be 21 years of age.Use of tobacco products inside the building is strictly prohibited. No alterations or improvements to the building allowed (no thumbtacks, nails, etc. in the wall.)Rental periods are for 6 hours, there will be a $50 fee per hour for each additional hour. LPUMC reserves the right to enter the premises during the event to inspect, terminate, or remedy problems. If damages are disclosed during an event, this will be considered a breach of contract. If this occurs, the use agreement may be terminated and the applicant/guest will be required to vacate the premises and use fees will not be refunded. For recurring meetings, the application period is from September through May. All groups must reapply yearly in August. Applicant must show proof of insurance, or sign a waiver that will hold La Plata United Methodist Church harmless from all injury and/or damage.Active Member is defined as regular church attendance and financial support of the church through your service, time, talents and contributions. ................
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