FOR ADMIN

USE ONLY Let Reference Number

APPLICATION FOR USE OF EDUCATIONAL PREMISES

Please return completed form at least 10 working days prior to the let to:
School Lets, Facilities Management, 3rd Floor, Burns House, Burns Statue Square, Ayr, KA7 1UT
Tel: 01292 612655 Email:

PROTECTION OF VULNERABLE GROUPS SCHEME (PVG)

If your membership is open to those who are 18 years or younger or if your let involves working with protected adults you will need to comply with theProtection of Vulnerable Groups (Scotland) Act 2007 (“the PVG Scheme”). See Guidance Notes attached and South Ayrshire Council Code of Practice for Adults Working with Young People Under 18 years of Age and protected adults.

Preferred Establishment:
Name of Group, Club or Organisation:
Name of Applicant:
Address Of Applicant:
Post Code:
Contact Telephone Number: / Home: / Work: / Mobile:
Contact e-mail address:

TYPE OF LET

(please tick  as appropriate)

/ One Off / Weekly / Fortnightly / Monthly
Specify Day of Week
Start Date of Let: / Finish Date of Let:

DETAILS OF LET

(Please include any start & clear up times required)

Purpose of Let:
Accommodation Required: / Time From / Time To / Accommodation Required: / Time From / Time To
Classroom / Grass Pitches
Main Hall / Changing Room
Games Hall / Lifelong Learning Suite
Gymnasium / * Kitchen
Dining Hall / * Servery

* Please note: Separate charges may be levied for use of kitchen and additional cleaning

Will the function have a liquor licence / Yes: No: See Section 12 – Conditions of Let

EQUIPMENT

No access will be given to equipment unless requested

Sound System / Yes: No:
Sports Equipment (Please Specify)
Synthetic Pitch / Time From / Time To / Synthetic Pitch / Time From / Time To
7-a-side / Floodlights
Half Pitch / Floodlights
11-a-side / Floodlights

GROUP COMPOSITION (Maximum Numbers)

Please ensure that you complete this section

0 – 7
years: / 8 – 18 years / 18 – 60 years / 60+
years

DISABILITY

Do you have any special requirements relating to the needs of any members of your group with a disability? / Yes: No:
If yes, please detail:

QUALIFICATIONS

Sports Instructors must have relevant and valid Governing Body qualifications/affiliations, and adhere to any guidelines for the specific activity. See Conditions of Let item 7.

PARKING

Please be considerate to surrounding properties when parking in and around your preferred establishment and be aware of any parking restrictions in place.

GROUP DETAILS

Please ensure that you complete this section
Does your group charge a fee? / Yes: No: If yes, please state fee £ :
Does your group have a constitution? / Yes: No:
Have you submitted it previously? / Yes: No:
If No, please enclose a copy of your Constitution with this Application for Let.
Have you received, understood and agree to complywith the conditions of the premise’s Fire Safety Information for lessees? / Yes: No:

DECLARATION

I am applying on behalf of the above Club, Group or Organisation for the use of the specified accommodation and if granted, agree that the Club, Group or Organisation will accept and abide by the terms of the Code of Practice & Conditions of School Let attached and signed by me and which I agree will be part of the whole Let Agreement.
I understand that I am responsible for any debt incurred as lessee.
Signed: ………………………………………………………………… Date: ……………………………………………….

The information provided is subject to the Data Protection Act (1998). Information may be shared with other Council Departments and External Agencies for stated purposes only.

FOR OFFICE USE ONLY

Are the proposed numbers for the Let within the capacity of the Hall? / Yes: / No:
Are arrangements in place as per section 9 of the South Ayrshire Council Corporate Safety Standard on Fire Safety revised June 2011 to ensure the safe evacuation of occupants in an emergency event? / Yes: / No:
The above let has been granted. / Yes: / No:
Cost per hour: / £ / Number of hours: / Other Charges: / £
Total Cost: / £ / Comments:
Signed: ………………………………………………………………… Date: ……………………………………………….