Phone: 016288556

Email:

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
( no charge/ fee to group members) / Community Group
( small sub/club fee charged and all proceeds used for group) / Commercial 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 / YES / NO / TYPE OF ACTIVITY
ROOM 1 / 65.5 / 80
ROOM 2 / 26.0 / 15
ROOM 3 / 38.2 / 30
ROOM 4 / 34.0 / 30
FUCTION HALL / 436.8 / 280
RIVER VIEW STUDIO / 42.0 / 20
K.W.H.(DOWN STRAIRS) / 41.0 / 40
SPORTS HALL / 459.0 / 100
ATTIC / 574.4 / 50
YOUTH CAFE / 172.9 / 50
OFFICE BLOCK:
LIFFEY ROOM / 36.2 / 20
OFFICE ROOM / 15.7 / 6
ABBEY VIEW ROOM / 18.15 / 12
OUTDOOR AREAS:
INTEL GARDEN / 150
K.W.H. GARDEN / 100
ROOM 1 GARDEN / 40

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? YES NO

TYPE OF INSURANCE AND LIMIT OF LIABILITY / COMPANY NAME / 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 ______Date ______

FOR OFFICE USE ONLY Booking No:______Date:______

Confirmed Booking: Yes/No Rental Amount agreed ______

Deposit received: Yes/ No Payment Method ______Staff ______

Deposit Amount Paid : ______Receipt No:______