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First Name

Last Name

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By checking the box below, you are agreeing you have read the RULES FOR FACILITY USAGE attached at the top of this form. You agree to comply to said rules and that the contact person listed on this form will be the person responsible for any damages to the premises and/or to any property. You also agree to indemnify and hold the church harmless from and against any loss, damages, suit, judgment or liability of any nature arising from damage to the facility, user’s personal property, or personal injury or death to any of the facility user’s members, agents, employees, or invitees.