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PO Box 664; 1576 Main Street
Pleasant Valley, NY 12569
(845) 635-3289

Building Use Application

Building Use Form last revised 10-2025
Select frequency of rental requested
Indicate which category pertains to your rental request:
Do you have insurance?

Please be specific in your request, i.e. “the first Thursday of every month”; “Every Tuesday”…

Start Date of Rental Requested
Month
Day
Year
Start Time
Time
HoursMinutes
End Time
Time
HoursMinutes
End Date of Rental
Month
Day
Year
Room Requested

Facility Use Policy:

1. You may expect to find others using other portions of the building simultaneously. The fees listed are for one-time use of the facility. Other fees for ongoing use may be negotiated with the Board of Trustees.

2. Scheduled building use may include permission for light use of the kitchen (beverages), but each group must provide its own supplies. Any food service beyond beverages must be coordinated with the Board of Trustees. Any Oven and/or Dishwasher use is by permission of the Board of Trustees before the event.

3. IN ORDER TO RESERVE THE FACILITIES:

(a) Contact the Church office (845-635-3289) for availability of the date for your event.

(b) Fill out ALL applicable forms and return them to the Church office.

(c) Trustees must approve the request upon approval, the Church office staff or a Member of the Board of Trustees will notify you

regarding your rental request.

(d) Church office receives the required deposits.

4. Smoking is strictly prohibited in this building.

5. There shall be no use and/ or presence of alcoholic beverages in any form in or around the building or property.

6. The event will begin and end within the time established on the agreement.

7. All furniture must remain in its respective room, and if temporarily rearranged, must be returned to the original placement.

8. Children must be supervised by parents or caregivers and stay in the rented area.

9. As part of the cleanup after an event, the rental group will pick up all trash on the floors, tables, chairs and any other furniture. The floor will be

broom-swept if necessary, and floor garbage will be picked up. (Broom and dustpan is available for use) All tables, chairs, and countertops will be

cleaned after use. Pour any liquids out of cups before disposing of them. All trash should be disposed of in the bag-lined trash cans. If needed, large black garbage bags are available for use. No adhesives, tapes, pins, nails, tacks, etc. may be used to secure decorations, announcements, etc. to the walls or windows. (Blue Painter's tape is preferred.)

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