Community Hall Hire Request Form

Your Details
Club/Organisation Name
Name
First Last
Phone (Business Hours)
Hire Request
Email
Facility Required
- Don Memorial Hall
- Melrose Community Hall
Hire Period Start Date
Date Format: MM slash DD slash YYYY
Hire Period End Date
Date Format: MM slash DD slash YYYY
Times Required (Start Time)

: HH

MM
Times Required (End Time)

: HH

MM
Function/Event Details
Will alcohol be sold to the public?
- Yes
- No
Please upload your Alcohol Permit
Public Liability Insurance
Certificate/Policy No.
Policy Expiry Date
Date Format: MM slash DD slash YYYY
Amount of Cover (Minimum $10M)
Please upload a copy of your PLI Certificate of Currency Here
Undertaking
I agree to this undertaking
I hereby make application for the premises set out in the Schedule attached to this application for the date(s) and time(s) specified in the Schedule and I acknowledge having received and read a copy of the Conditions of Hall Hire and undertake to be bound by and comply with the Conditions in every respect and I further undertake to be responsible for ensuring that all individuals or groups using the premises in association with this application shall comply with the conditions
- Yes
- No
Indemnity
I agree to this indemnity
The Hirer agrees to indemnify and keep indemnified and to Hold Harmless the Devonport City Council, its servants and agents and each of them from and against all actions, costs, claims, charges, expenses and damages whatsoever which may be brought or made or claimed against them arising out of or in relation to the hiring of the hall.
- Yes
- No
Privacy Collection Statement: Devonport City Council collects personal information for municipal purposes. The information collected in this form is used only for the purpose specified (primary purpose) and is not passed on to third parties. Council may disclose this information only if authorised or requested by law. Council may not be able to process your request unless sufficient information is given. Should you need to change or access your personal details, or you require further information about Council's Privacy Policy please contact Council's Privacy Officer.
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Your Details

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Undertaking

Indemnity

Acknowledgment

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