222 West Main Street - Waterbury, CT. 06702 - (203) 757-0331

Join Us For Sunday Worship at 10:00 AM - Children's Sunday School is at 10:00 AM

Instructions; Please fill out this application and then print the page and return to Roxanne at
Remember that you must read the use of building form and then fill out this information, print the page and then email Roxanne or call her at (203) 757-0331. For a PDF version of the application, please follow this link. By filling out this form it does not indicate that the church will rent or let you use the hall and you will be given further information and verification for you.

Online Application for Use of Building

Date of Application: Name of Organization
Contact Name:   Type of Organization:  
Address (1)   Address (2)
City:   State, Zip-Code  
Purpose of Organization:   Type of Event  
Is this event for a non-profit? If yes, who will it benefit?
Any admission fees? If yes, please state amounts;
Representative Contact Number Contact Email Address:
Representative Address: City, State, Zip-Code  
Are you a member of this church; Anticipated Attendance: (approximate)
 Enter end date;
Times: (Starting - Include Set-up) End Time (Include Breakdown)
Frequency If more than once enter dates:
Enter needs: Chairs
May charge for chairs over thirty.
May charge for chairs over fifteen.
Please Enter Other Needs such
as Stage, TV, kitchen, podiums, screens,
Please enter the rooms you are planning to use, such as main hall, kitchens, other rooms;
Use of Organ? Director of Music Clearance;
Certificate of insurance? Name of Insurance
Have you read the rules of use? Have you contacted Roxanne?

You must print this application and submit via fax, email or in person. If you have any questions you should contact Roxanne. Once you print and submit this application it will constitute as if you had completed the actual application. Please read and print a copy of this form and rules of use for your records. I, the undersigned, agree to comply with the rules and regulations as stated in the form I have read and printed. We will only those rooms assigned, and following the directions given by the Church Building Agent on duty. In addition you must provide proof of insurance through a certificate of insurance.  Additionally your event might require a Sexton to be on duty.

Please sign above