CVC Facilities Request Form

Contact Information

Requested by:

Your Email Address:

Your Phone:

Best Time/Method to Contact You:
Approved by Pastor/Dept Leader
(Enter name of the person who has approved Event/Class):

Event/Class Information

Name of Event or Class:

Date and Time of Event/Class:

Is this an Ongoing Class or One-Time Event:
   Ongoing Class
   One-Time Event

If this is an ongoing class, please indicate any specific dates you will NOT meet:

Estimate Number of Attendees:

Estimate Number Needed for Childcare:

Estimate Ages Needed for Childcare:

Specific Room Request:

Facilities Set-Up & Tech Needs

To make specific arrangements for Room Set-Up and Audio Equipment needs, contact Bonnie McPeck.

Sound Technician Needed
   Yes
   No

Audio & Equipment Needs: (Select all that apply and contact:
   None Needed
   VCR & TV
   DVD Player
   Overhead Projector
   Microphone(s)
   Keyboard
   Speakers
   CD/Cassette Player
   Music Stand
   Whiteboard/Markers
   Flip Chart
   Stool

Number of Chairs Needed

Number of Tables Needed

Other/Special Instructions: