BUILDING USE REQUEST FORM
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: _________
Representative,
Unity of the Valley _____________________________________________________Date: __________