Bethel Building Use Request Form

Organization Name

Today's Date

Name

This address will receive a confirmation email

Address

Phone

Date of event or meeting

Event time (From)

Event time (To)

Description of Event

Contact person during event

Contact phone #

If the event is a wedding, the date of the rehearsal

How many people will be attending?

Will you need to use any special equipment (i.e., projector, screen)? If you are using our sanctuary, there is a fee (listed below) for a trained person to run our sound equipment.

List any specific equipment needs

Security Deposit (This is a separate check written equal to total fee. Deposits will be refunded upon inspection following your event):

Please sign and return this page along with payment to Bethel Lutheran Church. Once we receive this signed contract and your payment, your time and date will be reserved on our calendar. Please read and keep the other sheets of information. In some instances, a copy of your organization's insurance certificate may be requested.

SIGNATURE/name

Date of Signature

Please check as appropriate:

I understand that the Bethel premises are alcohol-free, except during Communion services. I have read and will make my group aware of Bethel's PREVENTION OF INTERPERSONAL HARM policy (below) as we strive to create a safe environment for our meeting. The congregation should be aware of these committee meetings. Non-committee members should contact the chair if they would like to attend. My group is open and would welcome new attendees; please include in church opportunities when possible. My group enjoys privacy; please reserve the appropriate space for use and do not include in church opportunities.

Application For Use of Bethel Church Facilities

Statement of Prevention of Interpersonal Harm: As an ELCA, RIC congregation, we are committed to creating safe, welcoming, and inclusive environments in all areas of our worship, church life, and community involvement; this is something we take seriously. There can be no place here for harmful communication or exclusion of others. Should it happen or we encounter it in any form, we will acknowledge it and address it immediately. Harm is a physical or emotional injury caused by actions and/or words that discriminate or show bias or prejudice against another person or group. Harm includes, but is not limited to, racism, queerphobia, transphobia, antisemitism, Islamophobia, sexism, ableism, ageism, discrimination based on socioeconomic status, and, among others, immigration status. Harm can be subtle or direct, intentional or unintentional. Harm causes damage to all: those complicit in the behavior and those who experience it directly. As you engage in any conversation or use of personal and faith-enriching materials, please anticipate possible harm to others based on the identity categories above and be proactive at pointing harmful statements out to yourself and your Bethel group. Two important steps to follow: A) Quickly end harmful conversations with a clear statement indicating that harm is occurring; B) Respond with a forgiving mindset - acknowledge that we are all imperfect and in a state of constant learning. As a welcoming congregation, please be mindful of the values Bethel upholds. (Bethel Values: worship, community within, community outreach, and learning).

For office use only:

Date Deposit Received, By Whom, Check #, Copy to Church Accountant

Date Fee Received, By Whom, Check #, Copy to Church Accountant

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Bethel Building Use Request Form

Description

Please Fix the Following