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Rent A Room


     “Health, Happiness & Wholeness Are Just A Thought Away”

Thank you,

We appreciate you using Ki Empowerment Holistic Center for your upcoming workshop or event. Below you will find information about the center. Please fill out ALL information in the form below to submit your request.  

Conference Room / Classroom Rental = $20/hr                    Practitioner / Office Space = $10/hr

We do not allow the burning of sage, candles or incense.

*  You will be given the lock code to enter building after we have your rental agreement. If I have not 
   called you with the code please call Diane 614-738-2490614-738-2490

 Make checks payable to Ki Empowerment Holistic Center At the end of the hall by room 
   number 6, Diane’s office, there is a small lock box on the wall. If you have not prepaid for your event, place 
   your payment in the envelope.  Be sure to put
your name, date of event, and amount enclosed written on 
   the outside of the envelope.
Drop your envelope into the opening at the top of the box.

If the center is being used by others please be sure the people attending your workshop stay in the conference 
   room and do not congregate in the hallways talking.

The restrooms are in the hallway outside our suite.

*  We have a coffee pot and hot and cold water available. Please bring your own tea, coffee, creamer, sugar 
   and cups. Due to our low rental rate we do not supply these items for you. There is a small refrigerator  
Please help us keep our space free from spoiled food odors and rodents.  Ple
ase throw away left 
   over food, including food in the trash can, outside in the dumpster. It is located at the back of the building. 

*   You can adjust the heat from the thermostat in hall. There is a fan, heater and boom box in the conference  
   room that you are welcome to use.

* Tables and chairs are located behind the screens. Feel free to arrange the room to accommodate your 
   needs, but please return things like you found them.

In the event of heating or air-conditioning problems please call    Diane 614-738-2490614-738-2490. Or Steve 614-832-5358614-832-5358

 If you are the only event or person left in the center you are responsible for locking the office suite 
   door (two locks deadbolt & suite door) to the center and the exterior door located in the lobby. Check 
   the exterior door after locking sometimes it appears to be locked and it isn’t. Replace your keys in the 
   outside lockbox, spin the dials and close the small door on the lock.

If you have any problems or questions please feel free to call Diane 614-738-2490614-738-2490 or Steve at 614-832-5358614-832-5358.

Information for Website

  1. Name of event, class or workshop
  2. Is this event private or public
  3. Time of event
  4. Description of event to be cut and pasted onto our website.
  5. Cost
  6. How to register
  7. Contact Information name, phone email and your website if you would like a link to it.
  8. Bio information about the presenter.

It is important that people have a way to contact you. The phone at the center will not work as a contact number because most of the time it goes into voicemail. The 738-2490 number cannot be used as contact number.

If you would like to drop off written information about your class or workshop you can place it in the mailbox or mail it to the center attention Diane Allan-Clevenger and I will place it in the lobby.

      Thank you again, 
      Diane and Steve Clevenger

Room Rental Agreement

The CLASSROOM or OFFICE SPACE are available to rent on an hourly basis at

Ki Empowerment Holistic Center, 6797 N. High St., Suit 134 Worthington, OH

 The rental fee is due prior to use of space. ** Please note, the rental time specified below must include preparation time and clean up. The room is to be left in the same or in better condition than found. 

For your convenience, we have a whiteboard, projector screen, a conference table, and 4ft. Tables (for participants).  In addition, we have a projector available to rent.  

 Make checks payable to Ki Empowerment Holistic Center.  

 Rental Date(s) Desired:  
Event time to be posted on our website (am/pm)
Actual rental time (including set-up & tear down)
Conference Room / Classroom Rental 
Total # of hours
 Hours x $20.00 = Amount Due $
Office space
Total # of hours
Hours x $10.00 = Amount Due $
I would like to rent the projector for $20  AcceptDecline
Total Amount Due $
Responsible Renter
Renter's Address
Zip Code
Phone Number xxx-xxx-xxxx
E-mail Address
Cell Phone Number xxx-xxx-xxxx
Would you like a receipt for the event?  yesno
If yes, what name and email address you would like on the receipt?:
**  Please check boxes below to agree to the following terms  **
Prices are subject to change  Agreed
24 hour cancellation notice required.   Agreed
Half rental fee will be kept for failure to comply with 24 hour cancellation notice  Agreed
E-Signature of Responsible Renter
Ki-Empowerment Representatives Diane & Steve Clevenger

















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