Facility Request Form — DESTINY CHURCH

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Facility Use

State the purpose for which you intend to use the church facility:

Dates and Times:

Please list the date(s) and times.

Area(s) Requested:

Community Room

Kitchen

Classroom A

Classroom B

Additional:

State any special needs or requests, such as tables, chairs, etc.