Date Received: _______________

MISSION BEND

UNITED METHODIST CHURCH

3710 Hwy 6 South

Houston, TX  77082

(281) 497-4491

Fax (281) 497-3395

ROOM REQUEST FORM – CHURCH RELATED

Today’s Date: ____________________

Name of Group: _______________________________________________________

Name of Responsible Party: _____________________________________________

Address: _____________________________________________________________

City: ____________________________   State: _____   Zip: ____________________

Email Address:________________________________________________________

Day Phone No.: _____________________  Night Phone No.: __________________

Name of Person Reserving Space (if different from above): ___________________

Building/Room(s) Requested:

_____________________________________________________________________

Date(s) Requested: ____________________________________________________

Time(s) Requested: ____________________________________________________

Babysitting Needed: ____ yes                 ____ no

Special Room Requirements (if any):

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Confirmed date: ____________

Confirmed by: _____________

Confirm Information: _________________________________________________________________