Facility Request Form – Epiphany Episcopal Church

Event Name *

Point of Contact (POC) First & Last Name *

POC Phone Number *

POC Email *

Alternate POC (name, phone, & email)

Preffered Means of Contact *

Email
Telephone

Date of Event *

Recurring Event Dates (or day of the month - i.e. first Wednesday of the month)

Space Requested: Please check all that apply. *

Setup Time (Please specify A.M. or P.M.)

Start Time (Please specify A.M. or P.M.)

End Time (Please specify A.M. or P.M.)

Tear Down Time (Please specify A.M. or P.M.)

Approximate Number of people expected to attend/participate:

If outdoors, does it require fencing off?

Yes
No
Not applicable

Please let us know any additional details, such as will decorations be used (prior approval by the church is required), short term storage needs (and for what items), etc.

TECHNOLOGY NEEDS (check all that apply)

If this is a children/youth event, who is supervising?

IT IS A REQUIREMENT OF EPIPHANY EPISCOPAL CHURCH AND THE EPISCOPAL DIOCESES OF VIRGINIA THAT AT LEAST TWO ADULTS MUST BE PRESENT AT ALL TIMES AND AT ALL LOCATIONS USED FOR ANY EVENT INVOLVING CHILDREN DEFINED AS ANY PERSON UNDER THE AGE OF 18 YEARS. CHILDREN MUST BE ATTENDED BY NO FEWER THAN TWO ADULTS AT ANY TIME. By initialing the box below, you are agreeing to this requirement during the proposed event on the church property.

KITCHEN USE POC: If you will NOT be using the kitchen, please leave this section blank. If you will be using the kitchen, please put your kitchen lead as the contact.

Kitchen Use POC Phone Number

Kitchen Use POC Email

Please include any other details about kitchen use, such as short term kitchen food storage needs(refrigerator/freezer/pantry and what items), if an external caterer will be used (and contact information), etc.