DR. DELBERT A. MACK, SR.

VAN USE FORM

Name of Ministry(Required)

Ministry Director(Required)

Phone

Name of Person Requesting Van(Required)

Phone

CONTACT INFORMATION(Required)

Home Work Cell

Reason For Van Use(Required)

Date(s) of the Event

Departure Time

Return Time

Name

Name OF Van Driver(s) for Event Phone

(The driver must be approved, which means he/she is listed as a driver on the church’s auto insurance.)

How many people will be riding the van, including the driver?

Have you contacted the Director of Van Ministry?

Yes

Signature(Required)

Date