ST. ANDREW’S EPISCOPAL CHURCH
Ayer,
Telephone: 978-772-2615
BUILDING USE APPLICATION/AGREEMENT
Name of
Group/Organization ______________________________________________
Purpose of Use
__________________________________________________________
Types of Activities
Planned ________________________________________________
Estimated Number of
Participants _______________
Name of Contact
Person __________________________________________________
Address ________________________________________________________________
Phone #
__________________________________
Space requested: Parish Hall (PH) ___ PH Kitchen ___ PH Classroom ___
Peabody Room
___ Peabody Room Kitchen Facilities ___
Rectory Kitchen
___ Rectory Classroom ___
Beginning Date
__________________ Ending Date/Ongoing _________________
Day/days of Week
____________________________
Beginning
Time__________________ Ending Time ________________________
Charge $_________________________ Donation
$________________________
Signatures:
Applicant: I have read the attached Regulations for Building
Use of St. Andrew’s Episcopal Church facilities and agree to them.
______________________________ ___________________
Signed Date
Church Rep.: _____________________________ ___________________
Signed Date
The return to the applicant of this submitted form
signed by the Church’s representative constitutes a building use agreement
accepted by the Vestry of St. Andrew’s Episcopal Church. 11/07
November, 2007