Sicklerville United Methodist Church
406 Church Road
Sicklerville, New Jersey 08081
Fax: 856.728.5440

ROOM USAGE FORM
Note to Applicant: Please leave in Secretary's Mailbox or Fax to Church

Intake Date:
Ministry/Purpose:
Are you a member/regular attender of this Church?
  Yes    No
Are you a for-profit or a non-profit organization?
 For-profit?    Non-Profit?
Contact Person:
Complete Address:
Phone Number: 
DATE(S) and TIME(S) ROOM NEEDED:
 Date: Time:
Date: Time:
* Please note: Room usage on Wednesdays is limited to SUMC Ministries only.
Room usage in main complex on Sundays is limited to SUMC Ministries only.
Number of Rooms Needed:
      OR Specific Rooms Requested:
How Many People Will Be in the Room:
       Is Room Being Used by:  Adults?    Children?
If children are involved, what is ratio of adults to children?
       Children to Adults
Special Needs:
*If sound equipment is needed, you must fill out a Media Ministry Request Form
Miscellaneous Info:
Insurance for outside groups or not a ministry of SUMC:

A copy of Insurance Rider should be attached if applicable
If no Insurance Rider, Hold Harmless Agreement attached
Additional Issues to Consider:
1. If request is from another church:
     a. Are they incorporated? OR
          When will they be?
     b. What denomination:
     c. Are their beliefs similar to
           SUMC or in conflict?
2. How did you learn about us?

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STAFF USE ONLY:Staff comments/concerns to Trustees:
Trustee needed to open and/or close ________________________________________
Misc. concerns _________________________________________________________
Date to Trustees: _____________
Trustee approval granted: _________________________________ (date & Trustee initial)
Trustee denial (briefly state): _______________________________ (date & Trustee initial)
Date applicant notified of decision: ____________________________ (date & Staff initial)
____ Put dates on Sanctuary Calendar ____ Put on Room Usage ____ Notify Preston


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