Faith Lutheran Church, elca
Find Acceptance In This House

2740 Fuller Avenue NE
Grand Rapids, MI  49505-3746
Website:  www.faithlutheranchurchgr.org
Telephone:  616-361-2679
Email:  flcgr@att.net

LIABILITY WAIVER & FACILITIES USE REQUEST
Effective 3-18-18
To whomever it may concern,

By granting permission to individuals, to use land or facilities owned by Faith Lutheran Church, Faith Lutheran Church assumes no liability for injuries to persons or loss of property incurred by such use. 

I/we, the undersigned, absolve Faith Lutheran Church of all liability for injury or property loss incurred as the result of our use of Faith Lutheran Church land or facilities.

I/we, the undersigned, have read and understand the Building Use Policy and will adhere to the written guidelines.

Request facilities use for: 
Dates: _________________________________________________________________
Times: _________________________________________________________________ 
	
Request to use Room(s):  	

Frequency of use:  (1x), weekly, Monthly, etc.	

Fee: $__________________________________________________________________

Name of Group:   	

Individual making request: 	

Address of individual: 	
Street, City, State & Zip

Phone Day:	 Hrs  	or Evening	

Email: 	

Your Signature	Title	

Date Signed:   ___________________________________________________________

Approved by: ____________________________________________________________ 

Permission to use facilities of Faith Lutheran Church expires on the above scheduled activity’s end time & end date. (Copy to signer, 1 copy on file at Faith Lutheran Church)