Western Presbyterian Church - Building Usage Form

Please read before completing the usage form:

BUILDING USE
:  (A member of WPC may apply and must be present for the event.)
A. Approved church usage requires that the building, grounds, furniture, equipment, etc. be treated with respect and care.  The applicant is required to leave the facility neat and clean; and if food and drink are served, the area must be suitably cleared and food, drink, soiled paper plates, cups, etc. properly disposed of in the kitchen garbage cans or in the dumpster located in the rear parking area.
      Any leftover food is to be removed after the event.  If children are included in the group, supervision is expected.  Alcohol consumption and smoking are not permitted anywhere on church property.
B. The Use Fee and Damage Deposit will be required prior to loan out, and will be given to the WPC office.  Charges (Use Fee & Damage Deposit) for Building Use are shown below.
C. Use of the kitchen stoves, dishwasher, etc. requires a member of the church who is familiar with the operation of said items be present during use.
D. At the conclusion of the approved event, it is expected that the facility will be left in proper condition, and it is required that all lights (including bathrooms), equipment, etc. are turned off and, when applicable, the doors properly secured.
E. Only drinking water is allowed in the memorial parlor

LENDING OF TABLES AND CHAIRS
  1. Members and/or employees of Western Presbyterian Church may borrow tables and/or chairs for personal use in accordance with the Table and Chair Lending Charges shown below.
  2. Only wooden chairs are permitted to leave the building.  Padded chairs are NOT available to be loaned out!
B. The applicant will give the use fee and damage deposit to the WPC office prior to picking up tables and chairs.
C. WPC may limit the number of tables and chairs that may be loaned to any one person.  Persons borrowing the items:
   - are to provide the labor for transport
   - must stack the tables top to top to avoid scratching during transport.
   - will only use the tables and chairs located in the Fellowship Hall closet.
   - must lift and carry the items and not drag across the carpeting.
D. All tables and/or chairs are to be returned to church within 48 hours after pickup.
E. The use fee and damage deposit given to WPC will be required prior to pick up.  The damage deposit to be returned to the borrower after the tables and/or chairs are returned to the premises in proper condition.

 
Your Name*
Address*
Phone Number*
Facilities being used:
Email Address
Organization Name (if applicable)
Name of WPC Church Member involved
Signature of Applicant(s)
Date of application*
WPC Building Use
Description of Activity (or purpose of use*
Actual Time of Event Requested (Date*
Actual Event Start Time*
Actual Event End Time
Set-Up Date*
Set-up Start time
Facilities being used:*
Fellowship Hall
Fellowship Hall - AV screen
Fellowship HAll - Microphone, Handheld
Fellowship Hall - Usage fee $200 + damage deposit
Kitchen
Kitchen - Dishes/Utensils
Kitchen - dishwasher
Kitchen - Stove
Kitchen - towels etc
Kitchen - Usage fee $200 + damage deposit
Other Areas
Sanctuary - (upon Session Approval)
Sanctuary - Usage fee $400
Sanctuary - Microphone, hand held
Sanctuary - organ with organist, fee $150
Sanctuary - organ, you supply organist, Fee $100
Sanctuary - Piano
Sanctuary - sound system
Sexton/Custodian fee $100
Wedding Coordinator, Fee $125
Other:
Publicized Through The Church Office?
Table & Chair Rental
# of Tables Needed (taken from closet ONLY)
Table lending $2 per table + damage deposit
# of WOODEN chairs Needed
Padded chairs do NOT leave the building
Lending WOODEN chair fee $0.50 per chair + damage deposit
Pick-Up Date/Time
Return Date
Western Presbyterian Church
101 E. Main St. Palmyra, NY 14522

315-597-9171
Copyright Western Presbyterian Church, Palmyra NY, 2025
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