Key and Access Agreement – Grace Communion Surrey Hills

First Name *

Last Name *

Email *

Phone *

Role(s)/Position(s) *

List all roles/positions that will require various access.

Is external access needed? *

Yes
No

Areas of access - Exterior *

Main Entrance
Children & Youth Wing
MTC Wing

Select all that apply based on specific roles of responsibilities.

Keypad Areas of access - Interior *

Select all that apply based on specific roles of responsibilities. This will be areas where there is a digital keypad requiring an access code.

Device *

Key Fob
*Master Key - Main
*Master Key - Keypad Doors
Keypad Access ONLY

*Approval from the Pastoral Team is required to assign any Master Keys.

OH! HOLD UP!

For a Master Key(s) to be assigned, it is required that a member from the Pastoral Team approves this request.

Did a member of the Pastoral Team approve this request? *

Yes
No

Name of Pastoral Team member approving master key: *

4-Digit Access Code *

This is to be a 4-digit code to disarm/arm the alarm, as well as grant you access to role appropriate keypad areas.

Agreement

By signing below, you acknowledge that you have received the above devices and will abide by the policies for utilizing any access points and areas of the building for appropriate purposes based on your specific areas of serving at Grace Communion Surrey Hills. You agree that if a key fob is lost, stolen, or damaged, there will be a charge of $10 to replace key fob. If a master key is lost or stolen, there could be a charge to have all key locations rekeyed. You agree to return all devices (key fob, master key(s)) upon any role and/or responsibility changes that you encounter.

Signature *

Clear Signature

Today's Date *

Name of person assigning access *

First

Last

Signature of assigner *

Clear Signature