Church Keys
The following list is a compilation of individuals who currently possess keys to our facilities. Per Restore
Church’s Policy & Procedures Manual keys should not be duplicated without prior expressed consent. All keys
should be returned once there is no longer a need for the assigned individual to possess those keys.
Keys:
• Main Building (MB)
• Portable (P)
• Church Office (CO)
• Shed (S)
Date Individual MB P CO S Returned
Ministry / Department • Church Access Form
Please complete this form and submit to the church office at least one (1) month prior to your requested event
for review and approval. **Keys will be issued and need to be returned to the church office within 48 hours. A
cleaning checklist will be provided and space must be returned to the state it was in prior to your event.
Ministry/Department: ________________________________________________________________________
Ministry/Department Leader: __________________________________________________________________
Requestors Name:
___________________________________________________________________________
Phone Number: ______________________________ Email:
_________________________________________
Date Request Submitted: _____________________ Date Requested for Event: _________________
Purpose for use of building (briefly describe the event):
______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Space Requested: Sanctuary Fellowship Hall Kitchen Upstairs Classroom
Duration/Date & Timeframe of Event: ____________________________
Approximate Number of Individuals who will be present: __________________
*Person requesting access MUST be present throughout the duration and timeframe of the event.
Type of Event: Meeting Event (Event type: __________) Other: ______________ (training, workshop, etc)
Requestors Signature:
________________________________________________________________________
For Office Use Only:
Date Reviewed: ____________________ Approved Denied
Lead Pastor Signature: __________________________________________________ Date: ______________
If approved, keys issued: Yes No Cleaning Checklist Provided
After event, keys returned: Yes No
*If not approved, reason:
____________________________________________________________________
Updated: 4/11/2024
Tithes and Offerings Worksheet
Please complete this worksheet each time a monetary collection is done during a worship service at Restore
Church.
Date: _______________
Contributor Type Check # Amount
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Total Giving:
Attendance:
Worship: _________ Children’s Church: _________ Nursey: _________ Youth: _________ Other: _________
Total: _________
Signature: __________________________________________
Signature: __________________________________________
Updated: 4/11/2024
Request for Church Check
This form should be completed when there is a need for a church check. For “Reimbursement of Expenses”
please provide a receipt. For “Benevolence” please provide a copy of a utility bill, etc. For “Purchase” a
purchase order should be submitted with this request.
Date: ____________________
Reason: Reimbursement of Expenses Benevolence Purchase
Requestor: ________________________________________________________________________________
Amount of Check: _________________
Make check payable to: __________________________________________________________________
Address: __________________________________________________________________
__________________________________________________________________
Funds Needed for: __________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Requestor Signature: ________________________________________________________________________
For Office Use Only:
Approved Denied Check NOT issued, paid with credit/debit card.
Check #: _____________ Check Given: to ___________________ Mailed
Signature: _______________________________________________________ Date: ___________________
If denied, reason: _________________________________________________________________________
Notes: __________________________________________________________________________________
Updated: 4/11/2024
Purchase Order
Date: _________________
Ministry / Department: _______________________________________________________________________
Ministry/Department: ________________________________________________________________________
Ministry/Department Leader: __________________________________________________________________
Requestors Name: __________________________________________________________________________
Qty Description of Goods or Services Estimated Cost
TOTAL:
**It is the responsibility of the person incurring the charge to make sure there are funds available in either the General Fund or in a
special designated fund to cover the charge being incurred.**
I will make the purchase and attached receipts for reimbursement.
I would like a check payable to ________________________ to make purchase. *Request for Church Check
form should be submitted with this request.
I would like the church office to make this purchase.
The expense should be charged to: General Fund Designated Fund (______________________________)
Suggested Vendor: __________________________________________________________________________
Signature of Person Making Request: ___________________________________________________________
For Office Use Only:
Approved Denied
Purchase was made from: _____________________________________________ Confirmation #: ________
Signature: _______________________________________________________________________________
Updated: 4/11/2024
Accident / Incident Report
This form shall be used by church staff/members that witness or become aware of an accident/incident causing
injury and/or damage to property.
The report should be turned into the church office as soon as possible.
Person Completing this Report: ________________________________________________________________
Reason for Report: __________________________________________________________________________
Date of Accident/Incident: ______________________ Time: ________________
Place of Accident/Incident: ___________________________________________________________________
Name(s)/Age(s) Injured:
______________________________________________________________________
Address: __________________________________________________________________________________
__________________________________________________________________________________________
(Add others if necessary)
Property Damaged:
__________________________________________________________________________
__________________________________________________________________________________________
Briefly Described What Happened: _____________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Ambulance Called: Yes No
Comments: ________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
1 of 3
Accident / Incident Report
What action did you take or was taken at the time of accident/incident? ________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Were there any witnesses? Yes No
List those who witnessed the accident/incident
Name: ____________________________________________________________ Phone: _________________
Name: ____________________________________________________________ Phone: _________________
Name: ____________________________________________________________ Phone: _________________
Name: ____________________________________________________________ Phone: _________________
Name: ____________________________________________________________ Phone: _________________
Has the cause of the accident/incident been removed? Yes No
Explain: __________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Are there any follow-up steps you believe should be taken? __________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Incident Report Completed by,
Signature: __________________________________________________ Date: _________________________
2 of 3
Accident / Incident Report
For Office Use Only:
Was the Insurance Company Notified: Yes No
If yes, a separate accident report will need to be completed. This will be provided by the insurance carrier.
Date contact was made with injured party: _____________________
Name of church staff following up: _____________________________________________
Briefly describe what the injured party alleged happened: _________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Is additional investigation needed? Yes No
Explain: ________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Was the accident/incident reported to local authorities? Yes No
By whom: _______________________________________________________________________________
Reported to: ________________________________________ Date: ________________ Time: __________
Investigation Police Officer: ________________________________________________________________
Star/Badge #: _________________
Signature of Staff Member: ___________________________________________ Date: _________________
This report should be kept on file in the church office for a minimum of three (3) years.
3 of 3
Updated: 4/11/2024
Checklist – After Fellowship Hall / Kitchen Use
Please make sure the following checklist is completed following the use of the kitchen. It is our desire to make
the use of the kitchen both convenient and safe for all. Turn in the completed form to the church office
following your event.
Ministry / Group: ___________________________________________________________________________
Contact Person:
_____________________________________________________________________________
Phone: ______________________________________
Email: ____________________________________________________________________________________
What equipment and/or supplies did you use? (check all that apply)
Pantry Freezer Refrigerator Stove Oven Coffee pot Soup warmer Coffee carafes
Other: ______________________________
Pots, pans, serving pieces, and all utensils have been cleaned and returned to their proper place.
Dish towels have been placed in the laundry basket in the pantry.
Leftover food/drinks have been thrown away (or taken home). Do not leave any opened food/drinks in the
pantry, refrigerator or kitchen.
ALL personal dishes have been washed & taken home. Nothing is left in the kitchen.
RESTORE CHURCH MINISTRIES ONLY
List quantities of paper goods used: plates _____ bowls _____ disposable utensils _____
napkins _____ coffee/drink cups _____
FELLOWSHIP HALL
All surfaces have been wiped clean, including tables, chairs and highchairs
Kitchen has been swept and mopped.
All trash has been taken out and trash cans have no liners in them.
Stove: surface units and oven are off.
Doors are locked and lights are turned off.
Restrooms has been checked to ensure faucets are off, floors are clean and lights are off.
Heat/AC units are turned off.
Checklist – is completed and returned to the church office.
Signature of Ministry/Group Contact: ___________________________________________________________
For Office Use Only:
All areas/items used have been satisfactory cleaned and returned in good condition.
Signature: _____________________________________________________ Date: ___________________
Updated: 4/11/2024
3276 Main Street
Cottondale, FL 32431
(850) 325-0324
Parental Consent and Medical Authorization
Participants Name: ____________________________________________ Date of Birth: __________________
Address: ______________________________________________ City/State/Zip: _______________________
Phone: ___________________________
Parent/Guardian Name: ______________________________________________________________________
Cell Phone: ________________________ Work Phone: ________________________
Other numbers were parent/guardian may be reached during event: _________________________
Event: ____________________________________________________________________________________
Duration: Start date/time: ____________ End date/time: ____________
Consent and Liability Wavier
I hereby consent to participation by my son or daughter, in the event described above. I fully understand that this event may take place
away from the church grounds and that my child will be under the supervision of the designated staff and/or volunteers on the stated
dates. I also consent that, if transportation is provided to said event, it may be by private car when necessary. I understand that such an
undertaking involves an element of risk. I assume all risk and hazards incidental to such participation and do hereby release, absolve,
indemnify, and agree to hold harmless RESTORE CHURCH OF JACKSON COUNTY, FL, INC, and its agents and the owner and/or
driver of the car furnishing transportation to any event, from any and all liability that may arise out of participation in this activity. I
give consent for emergency medical treatment, if necessary, as determined by the trip chaperones. I agree to hold harmless and
release RESTORE CHURCH OF JACKSON COUNTY, FL, INC and its agents from any and all liability related to expenses arising
from the giving of such medical care. As parent/legal guardian, I remain fully liable or any legal responsibility which may result from
any personal actions taken by the named participant.
In addition, I hereby grant permission to RESTORE CHURCH OF JACKSON COUNTY, FL, INC to use my child’s likeness on its
promotional materials including videos, websites, social media, and printed materials without further consideration, and I
acknowledge RESTORE CHURCH OF JACKSON COUNTY, FL, INC right to crop or treat the likeness at its discretion.
I consent to the conditions stated above, including the method of transportation.
Parents/Guardian Signature: _____________________________________________________________ Date:
___________________
Telephone #: Day: _______________________ Night: _______________________
Alternate Emergency Contact: ___________________________________________________________________________________
Telephone #: Day: _______________________ Night: _______________________
Allergies or Medical Concerns: (use back for more space)
______________________________________________________________
Doctor’s Name: ________________________________________________________ Phone Number: _________________________
Insurance Company: ____________________________________________________ Policy Number: _________________________
Notary Stamp/Seal, Date and Signature:
____________________________________________________________________________
Updated: 4/11/2024
Non-church Related Event • Church Access Form
Please complete this form and submit to the church office at least one (1) month prior to your requested event
for review and approval. **Keys will be issued and need to be returned to the church office within 48 hours. A
cleaning checklist will be provided and space must be returned to the state it was in prior to your event.
A $50 refundable deposit is due when submitting this form. Rental fees are due upon approval of request.
Requestors Name:
___________________________________________________________________________
Phone Number: ______________________________ Email:
_________________________________________
Date Request Submitted: _____________________ Date Requested for Event: _________________
Purpose for use of building (briefly describe the event):
______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Space Requested: Sanctuary Fellowship Hall Kitchen Upstairs Classroom
Duration/Date & Timeframe of Event: ____________________________
Approximate Number of Individuals who will be present: __________________
*Person requesting access MUST be present throughout the duration and timeframe of the event.
Type of Event: Meeting Event (Event type: __________) Other: ______________ (training, workshop, etc)
Requestors Signature:
________________________________________________________________________
For Office Use Only:
Date Reviewed: ____________________ Approved Denied
Lead Pastor Signature: __________________________________________________ Date: ______________
If approved, keys issued: Yes No Cleaning Checklist Provided
After event, keys returned: Yes No
Deposit Paid Rental Fee Paid Deposit refunded
*If not approved, reason:
____________________________________________________________________
Updated: 4/24/2024
