Office Use Only: Date Received___/___/____ Priority______ Date Entered ___/___/____

Single Date Facilities Scheduling Request Form Please fill out this form with your request for use of facilities. It is important that you fill out this information exactly. Today’s Date ___/___/_____ Event Name _______________________________________________ Organization _________________________________________________________________________ Contact Person _________________________________________________________________________ Address _________________________________________________________________________ City/State ____________________________________ Zip/Postal Code _________________ Phone (______) ______ - ______________ Fax (______) ______ - ______________ E-mail ___________________________________________________________________ What facility do you wish to use? ___________________________________________________________  Church  Classroom 2  Classroom 3  Field Back  Field Front  Gazebo

 Classroom 4  Classroom 5  Classroom 6

 Grotto Room  Kitchen

 Library 7/8

 Main Hall  Music Annex  Conference Room  Screen Room  Stage Area  Movie Room  Youth Office  Parking Lot-Back

 Parking Lot-Basketball Court Playground

Second choice? __________________________________________________________________________ What date do you require? ______/_______/_________ What time do you need? Beginning: ___________(am)(pm) Ending: ___________(am)(pm) Setup: ___________ (minutes) Cleanup: ___________(minutes) Approximate number of people: ________________________________ Other Comments (Number of tables, chairs, etc.) ____________________________________________ _________________________________________________________________________ _________________________________________________________________________ Note: 1. Refer to Parish Facilities Guidelines for additional information on facility usage. 2. Request for multiple dates and times, please use Multi-Use Facilities Scheduling Request Form. Please return this form to the parish office as soon as possible. You will be notified when your request has been approved. If there are any changes to this request, please contact the parish office as soon as possible. Parish office must be notified when a meeting is CANCELLED by email, US Mail or by phone, if within 24 hours. Failure to cancel may result in loss of usage in the future.

St. Mary Catholic Church 15520 North Boulevard Tampa, FL 33613-1122 (813) 961-1061 + Fax: (813) 961-3782