Application for Building Use


Rental Use Only


350 N. Orchard Avenue * Vacaville, CA 95688 * (707) 447-0521 * Fax (707) 447-5489



Date(s) Requested: _______________________________________________________________________


Group or Organization: ____________________________________________________________________


Brief Description of Group: _________________________________________________________________

EVENT:  On-going _______    Start Time: ________ End Time: ________ Monthly Payment $____________


              One-time _______    Start Time: ________ End Time: ________ Payment Amount $____________


Number of People: _________ Room(s) Requested: _____________________________________________


Reason for Request: ______________________________________________________________________


Key(s) given: Yes____ No____  Key No & Ltr _____________________________  Date:________________


Person making request:  ___________________________________________________________________


Address: _______________________________________________________________________________


Phone #: __________________ Cell #: _________________ Email: _______________________________



The undersigned person is an authorized official of the group requesting room use, has read the attached Building Use Policies, and agrees to share this information with the other members of their group.


It is clearly understood and agreed that the undersigned person and the group requesting room use assume all risk for loss, damage, liability, injury, cost or expense that may arise during, or be caused in any way by, their use of the facility.  The group requesting room use will be required to supply a Certificate of Insurance naming the church as additional insured.


By signing the request form you hereby agree to hold free and harmless Unity of the Valley, their agents and employees from any loss, claim, liability or damage, and/or injury to any person(s) and property that in any way may be caused by the group’s use or occupancy of these facilities. A Certificate of Insurance naming the church (Vacaville Unity Church of the Valley) as additional insured must be provided at least one (1) week prior to the date of use.


Signed: ________________________________ Group: ________________________Date: _________



Unity of the Valley _____________________________________________________Date: __________