Application for Hire - Regular Hirer » Wollondilly Shire Council

Please read Conditions of Hire for Council Halls & Community Centres before completing this form.

I have read and understand the conditions of hire.

Name of Hirer/Organisation

Applicant (Name)

Position with Organisation

Phone

Postal Address

Email

I have been authorised to act on behalf of

Facility Name

Area Required

Purpose of Hire

How often do you require the facility?

If other, please state

Commencement Date

Finish Date

Booking Details (please list days and times required)

Approximate number of participants enrolled in your activities at this facility

Do you require the facility during school holidays?

Do you require the facility on public holidays?

Are you a Not For Profit Organisation?

If yes, please upload proof of Not for Profit status

Will Alcohol be sold or consumed at any time during your hire?

If you do intend to sell alcohol, please upload your Liquor Licence

Are you suitably qualified and licenced for the activities that you will conduct in the hall?

Will you play music when using the hall?

If yes, a copy of your APRA and PPCA licences must be provided with your booking

Please advise of any further requirements in respect of your hire of the facility

Proof of your Club/Organisations Public Liability Insurance Policy (minimum coverage required $10,000,000) in the form of a Certificate of Currency must be provided with your application. Please attach a copy to this application.

Public Liability

Insurer

Policy Number

Expiry Date

There is a refundable key deposit of $25.00 for each key issued

Number of Keys Required

Name

Address

Phone

Name (if required)

Address

Phone

I, the hirer confirm that I am over 21 years of age.

I have read and understand the accompanying Conditions of Hire. I understand that the Management Committee or Council reserve the right to cancel Approval to Hire if:

Payment is not made by the due date;
Any significant change to the original intended purpose for the use of the facility occurs;
The conditions of Hire are breached.

I undertake to be responsible for the payment of Fees, Charges and Bonds fixed by Council for hire of the facility and any additional charges arising out of hiring in accordance with the Conditions of Hire and which we agree shall apply to and form the basis of this application.

New Hirer’s must provide proof of identity. A Drivers Licence or similar original proof of identity document is to be sighted by a Council Officer or Management Committee representative prior to the release of the keys to the facility.

Privacy Statement: Wollondilly Shire Council is collecting personal information from you on this form for the purpose of assisting the determination process of your application. This information is required by law and failure to provide the information may lead to rejection or delays of your application. At any time you have the right to access, view or correct the personal information that you have provided. Please also note that information supplied on this document may be the subject of a request to access information under the Government Information (Public Access) Act 2009 (GIPPA)