Room Request Form - Zion Lutheran

Name of Organization or Individuals*

Address*

Street Address Address Line 2 City State ZIP Code

Contact Person*

First Last

Purpose of Use, Organization, or Individual*

Request

Person directly responsible for Kitchen, if requested above

First Last

Education Wing

Date Requested*

List additional dates here:

Time Requested Start*

:

Time Requested End*

:

Number of People*

Please enter a number greater than or equal to 1.

Person directly responsible*

First Last

Address of person directly responsible*

Street Address Address Line 2 City State ZIP Code

Phone of person directly responsible*

Email of person directly responsible*

Non-profit organization?*

Name*

First Last

Waiver of liability: We hereby release Zion Lutheran Church from responsibility

Email*

I have read and understand the policy.*