REQUEST FOR USE OF SPACE First United Methodist Church, 428 Kenwood Avenue Delmar, NY 12054 Phone: 518-439-9976 www.delmarmethodist.org Email: churchoffice@delmarmethodist.org PLEASE PRINT (w/ink) Person/Group/Organization Requesting Office Use Only Organization: Room: Day(s): Time: Use:______________ Den/Pack/Troop(circle one) and #____ Purpose for Use of Space:__________________ Mailing Address:____________________ Email:________________________ Name of Responsible Adult (providing supervision): ____________________Phone:_____ Date(s) of Use (please include dates for entire program calendar requested below or on additional sheet): ___________________________ ___________________________ _____________ Hours (include set up/clean up): ____AM to__PM (√) Space Requested (room capacity) Donation (√) Classroom (25) N/C Community service opportunities will be shared with leaders and participation is encouraged in lieu of fees TOTAL N/C Confirmation will be sent upon receipt of all materials/donations requested. Please return all forms requested with your donation (payable to FUMC Delmar) to: First United Methodist Church, Attn. Nan 428 Kenwood Avenue, Delmar, NY 12054 OFFICE USE ONLY Cert. Liability___ LOU___

(√)	Space Requested (room capacity)	Donation
(√)	Classroom (25)	N/C Community service opportunities will be shared with leaders and participation is encouraged in lieu of fees
	TOTAL	N/C

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Original PDF: DELMARUMCncUSEOFSPACE.pdf