God our Father - Christ our Redeemer - Holy Spirit our Comforter - Humankind our Family

Historic Liberty Hill AME Church | 2310 Liberty Hill Road   PO Box 744 |  Summerton, SC 29148  |  803-478-4812  (ph)  |  803-478-4891  (fax)

©2012 -2014 Historic Liberty Hill African Methodist Episcopal Church

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Historic Liberty Hill African Methodist Episcopal Church

2310 Liberty Hill Road                                                                                                                                                                 803-478-4812   Office

Post Office Box 744                                                                                                                                                                        803-478-4891   Fax

Summerton, South Carolina 29148                                                                                                                                       church@ftc-i.net     Email


Use of Educational Building

Name of Group or Organization_____________________________________________________________________________________


Telephone Number of Contact Person________________________________________________________________________________

Date(s) of Use__________________________________________________________________________________________________

Time In_______________________________________________        Time Out______________________________________________

Purpose of Use_________________________________________________________________________________________________




Will you need use of the kitchen? __________________yes ______________________no

Will you need service of Liberty Hill Food Service Ministry? __________Yes  __________no

Expected number of persons attending_________________________________________

                               Rental                             Deposit

*Liberty Hill member                                            $150.00*                         $150.00*

  Liberty Hill member                                             $300.00                          $300.00

  Non-member                                                       $500.00                          $500.00

Signature of Contact Person _________________________________________________________Date________________________

Printed Name ________________________________________________________________________________________________

Signature of Church Official _____________________________________________________________________________________

January 13, 2014

*One time per year, member who is in good and regular standing in the church, based on your financial support to the church from the monthly class leader’s reports.

A deposit, equal to the stated cost of the rental fee, is required. The deposit check will be held until the building is inspected. If no additional clean-up is needed, the deposit will be returned. If additional clean-up is needed, the check will be deposited and the cost of the clean-up will be deducted from the deposit. The balance, if any, of the deposit will be returned. You will also receive a copy of the bill for the clean-up.