Phone: 016288556
Email: [email protected]
Celbridge Mill Community Centre Booking Application Form
1. Hirer’s Details
CLUB /GROUP
Home Phone
Contact Person
Work Phone
Position Held
Mobile Phone
Address
Email Address
Fax Number
Name of Event
Num. of Participants
2. Classification
Voluntary & Senior Hire rate
Community Group
Commercial Group
( no charge/ fee to group members)
( small sub/club fee charged and all
proceeds used for group)
( tuition fees/ payment to individuals)
(Please teak relevant box)
Once Off
Seasonal
Annual
(Please teak relevant box)
Please tick which age bracket will be using the facilities from your group and give approx. number in each.
0-4 yrs
4-7 yrs
8-11 yrs
12-15 yrs
16-18 yrs
18+ yrs
Senior
citizens
3. FACILITIES AVAILABLE FOR HIRE (please tick your preference and state your type of activity)
AREAS
SIZE
QUOTA
ROOM 1
ROOM 2
ROOM 3
ROOM 4
FUCTION HALL
RIVER VIEW STUDIO
K.W.H.(DOWN STRAIRS)
SPORTS HALL
ATTIC
YOUTH CAFE
OFFICE BLOCK:
LIFFEY ROOM
OFFICE ROOM
ABBEY VIEW ROOM
OUTDOOR AREAS:
INTEL GARDEN
K.W.H. GARDEN
ROOM 1 GARDEN
65.5
26.0
38.2
34.0
436.8
42.0
41.0
459.0
574.4
172.9
80
15
30
30
280
20
40
100
50
50
36.2
15.7
18.15
20
6
12
150
100
40
YES
NO
TYPE OF
ACTIVITY
Celbridge Mill Community Centre Booking Application cont’d
4. BOOKING DETAILS
DATE REQUIRED
DAY/EVENT
AM/PM
AM/PM
BOOKING ARE HOURLY, PLEASE NOTE THAT YOUR BOOKING TIMES MUST INCLUDE WARM UP, SET UP AND
PACK UP. PLEASE ENSURE THAT ALL EQUIPMENT IS RETURNED TO ITS ORIGIONAL POSITION BEFORE THE END
OF YOUR SESSION.
5. EQUIPMENT REQUIRED
YES
NO
If yes please outline your requirements. Please note it is a condition of hire that the cost for any damage /
repair occurring to this equipment will be billed back to the hirer.
6. INSURANCE
Does your group hold a current public liability policy?
TYPE OF INSURANCE
AND LIMIT OF
LIABILITY
COMPANY NAME
YES
NO
POLICY NUMBER
COMMENCEMENT
AND EXPIRE DATES
(A COPY OF YOUR INSURANCE POLICY MUST BE SUBMITTED TO CELBRIDGE MILL COMMUNITY CENTRE WITH
YOUR SIGNED CONDITIONS OF HIRE)
WE REQUIRE THAT CELBRIDGE COMMUNITY CENTRE LTD IS INDEMNIFIED ON THE POLICY
7. PAYMENT ARANGEMENTS (PLEASE TICK)
Pay by cash, Visa, cheque (over the counter)
Weekly / Monthly/ Term Invoice
8. HIRER’S SIGNATURE I understand the Conditions of Hire and confirm that I accept them on behalf of my group /
organisation and confirm that the above organisation holds a public liability policy.
Signature _________________________________________________
FOR OFFICE USE ONLY
Booking No:_______________
Confirmed Booking: Yes/No
Rental Amount agreed _______________
Deposit received: Yes/ No
Payment Method _____________________
Deposit Amount Paid : ____________
Receipt No:___________________
Date _________________
Date:_________________
Staff ______________