Sample Incident Form for Church Rentals?

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Hi! This question has not been answered yet. Can you help?

Nellie over at First CRC in Guelph, ON, here. I'm looking for a sample incident form to include with church rentals. Does your church have one? Any ideas? 

In the meantime, I've attached a draft incident form I created. I wanted to toss it into the ring if it might be helpful. 

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