Request for Use of St. Mary Facilities Form
St. Mary Parish, Dover, N.H.
Phone: 742-2619       Fax: 742-7166
Email: domcaeruleus@comcast.net

 

  Facility Requested:  Parish Hall       Conference Room       Parish Church

     For One-Time Event:   Date of Event

     For On-Going Event:   Begin Date    and Continuing Every 
                                                                                 (or )  and Continuing Every        of the Month

                                         End Date  

              Hours of Event:   Begin Time    End Time

      Organization Name:  

             Contact Person:  

             Daytime Phone:        

             Evening Phone:        

             E-Mail Address: 

          Number of People:                        

    Set-Up Requirements: 

            Date Submitted:  

         Request Made By:     Phone Number       

Please Note:

  (1) Certificate of Insurance is required six weeks in advance of event,  or fee to be paid to Diocese of Manchester
        for insurance coverage.
  (2)  Donation for use of facility  is $50.00 for Parishioners, and $350.00 for non-Parishioners
  (3)  Set-Up/Clean-Up Fee is $75.00
  (4)  Do not leave perishables in refrigerator.
  (5)  If trash is excessive and requires extra dumpster pick-up, a fee of $75.00 will be charged.

           ------------------------------------- For Office Use Only ----------------------------------

      Approved and Confirmed by:      Date:
                 Confirmation Sent By:       Date:
         Copy to Office Staff:   Date:         By:
                 Copy to Sexton:   Date:         By:
         Posted on Calendar:    Date:         By:
      Posted in Mass Book:    Date:         By:

        

Ken Gray
St. Mary Parish
All rights reserved.
Revised: 06/15/08