The undersigned assumes liability for any damage to the building facilities, piano, organ, or any equipment used during this event and related activities (rehearsal, setup, etc). A member of the staff of Central Presbyterian Church must supervise movement of the piano.

The undersigned also assumes liability for any loss of or damage to personal property belong to any attendee or participant, and for bodily injury suffered by any attendee or participant during this event and other activities related to this event.

Signature: ________________________________________ Date:___________________

Please return this form and the event request form, and, if charging an admission fee, a letter detailing information about the event and the charge, to:

Central Presbyterian Church
Attn: Office Manager
200 East Eighth St.
Austin, TX. 78701

Telephone: 512-472-2445 or fax: 512-472-2446

For office use only:

Accept________________________________ Decline: _________________________

Pastor's signature (if required) _____________________________________________

Deposit received: Check # _________ amount: __________ date received: _____________

Payment received to church: _______________ For custodian: _____________________

Hours church will be open: __________________

Updated: 12 Jan 2009