Building & Usage Form

Submit Facility Usage Request Form

GRACE LUTHERAN CHURCH

1300 Kishwaukee Valley Road Woodstock, IL 60098
Phone: 815-338-0554 Fax: 815-338-0913

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In order to serve the members and guests who use the facilities of Grace Lutheran Church in the best possible way, we ask that you complete and return this form to the Church Office at least fourteen (14) days before your event. Completing this form will also help ensure that this event will be listed on our church calendar. If you are requesting the use of the kitchen, a Certified Food Protection Manager is required. Please provide us with the name of your Certified Food Protection Manager on the facility usage form below. If you need help obtaining a food protection manager, please note that on the form and we will try and assist you. Thank you for your consideration.

Denise Klabunde, Administrative Secretary

–Ken Zank, Building Superintendent

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Name of Event, Group or Organization: *

Date(s) Requested: *

Time Requested: *

Will Grace Lutheran’s Facilities Be Used? *

If Yes, Desired Room(s): *

If you are requesting the use of the kitchen, list the name of your Certified Food Protection Manager. *

Do you need help with obtaining a Certified Food Protection Manager? *

Number of People to Attend Event *

Describe Your Function or Activity: *

Other Equipment Requested: *

** Fees (when applicable):

Contact Person Name: *

Contact Person Email: *

Contact Person Telephone Number: *

Today’s Date: *

Do you accept the following? *

Fees for the usage of the church facilities are to be paid seven (7) working days prior to the event. Each group that uses Grace Lutheran facilities is responsible to set up, clean-up and return the room(s) according to the chart posted on the wall. Grace Lutheran will be closed at 10:00 p.m. each evening.

Do you accept the following? *

Groups requiring a fee for the use of Grace utheran’s facilities must provide Certificate of Insurance Request Form, Hold Harmless Agreement (notarized) and the Certificate of Liability from their personal insurance carrier naming Grace Lutheran Church as an additional insured prior to the planned event. You may obtain this certificate by calling the agency that has issued your homeowners and/or auto insurance and ask them to Fax, E-mail or mail a Certificate of Liability Insurance to Grace Lutheran.

Do you accept the following? *

By submitting this form, I agree that our group/organization will comply with all IDPH requirements and guidelines in effect at the time of the event.

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