Online Form - Request for Hire - Kambalda Facilities

Name of Organisation

Name of Applicant

Postal Address

Email Address (your booking confirmation will be sent to this address)

Not-For-Profit

YesNo

Home Number

Mobile Number

Food Consumption

YesNo

Caterer Details

YesNo

Caterer Contact Details

Number of Persons

Have you used this Facility before

YesNo

Alcohol Consumption

YesNo

Food Sold

YesNo

Alcohol Sold

YesNo

Liquor License

YesNo

Will any structures be erected?

YesNo

Security present

YesNo

Qualified first aider onsite?

YesNo

Days requested*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday

Date(s) Requested

Start Time (incl. set up)

Finish Time (incl.clean up)

FACILITIES or PARKS (check all required)*

StadiumIndoor court 1Indoor court 2StageOutdoorOutdoor court 1Outdoor court 2Function room 1Function room 2 (window side)KitchenKioskMeeting roomsCommunity RoomSmall Room 1Small Room 2Library (video conference)Kambalda West OvalLions ParkKambalda Memorial GardenSara Jane Wilson ParkRymer ParkWilliam Wenzel ParkHarry Steinhauser OvalDonkin ParkJohn Morgan ParkGillies McPherson ParkHarry Stenhauser Reserve Playground and Nature Playground

EQUIPMENT (check all required) - Items marked with an * will be at an additional cost. Equipment must be signed out at the commencement of the hire and signed back in upon completion of your booking. All items are the hirer’s responsibility and are to be set up/packed away by the hirer within the designated booking time.

Projector & Screen*HDMI CableAUX CordMicrophone & StandPA SystemLaptopChairsLecternWhiteboardTrestle TablesRound TablesTablecloths* Indoor Court Protection*Smartboard*

Special Instructions/ Additional Information

Layout /Seating

TheatreClassroomSmall meetingDinnerCocktail PartyOther

Do you agree to adhere to the terms and conditions (please see link above to download full terms and conditions.) By ticking yes, you confirm agreement with conditions.

Yes