Request For Use of Facilities | St John Lutheran Church

Please Note: The Fellowship Hall is not available for rent on Saturdays before 3:00 PM unless the renter can agree to cancel or reschedule their planned activity in the event of a funeral on Saturday morning.

Activity: (Required)

Date of Event: (Required)

Time(s) of Event: (Required)

Number of people expected: (Required)

Times access required: (Required)

Room(s) requested: (Required)

Use of commercial kitchen equipment and sound room equipment is not allowed

Fellowship Hall

Kitchen

Sanctuary

Other

If Other, please specify:

Equipment Requested

Number of Rectangular Tables:

Number of Round Tables:

Number of Chairs:

Other Special Needs:

Group Information

Group/Person making request: (Required)

Responsible Party: (Required)

Address: (Required)

Phone: (Required)

Contact person (if other than Responsible Party):

Address:

Phone:

Confirm that you read the Faith Statement (Required)

I have read the Faith Statement

Confirm that you agree to the Hold Harmless statement (Required)

In consideration of the permit to use St. John’s Lutheran Church facilities herein before described, the undersigned user hereby agrees to indemnify, defend and hold St. John’s Lutheran Church harmless from and against any claims, actions or demands alleging that St. John’s Lutheran Church has any liability to any third party arising from the subject use of the facilities. St. John’s Lutheran Church is not liable for any direct, indirect, incidental, special or consequential damages, including loss of profits, revenue, data or use or cost of procurement of substitute services or goods incurred by user or any third party, arising out of the use of the premises permitted herein. Such indemnity extends to St. John’s Lutheran Church, its members, agents, employees, successors and assigns.

I agree to the Hold Harmless statement

Agreement

I have read the conditions outlined on the Guidelines for Use of Facility form, Faith Statement and Hold Harmless Agreement, and agree to abide by same, and to make every effort to insure that our guests do likewise, if we are permitted to use this facility. I agree to make any necessary remuneration to the church office at least 30 days prior to the event.

Signature of Responsible Party: (Required)

Date: (Required)

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St John Lutheran Church

700 Heritage Road
Luxemburg, WI 54217

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