Venue Booking Form ~ Blackheath Area Neighbourhood Centre

(Please note that this form is to submit a booking request. Your booking is not confirmed until it has been reviewed and the fee payment has been made)

First Name*

Last Name*

Company Name

Email Address*

Street Number & Name*

Suburb*

State*

Postcode*

Phone Number – Mobile or Landline*

Name & Description of Function*

Areas Required*

One Off Event Date

One Off Event Times (incude set up and pack up) (e.g. 10am – 11am)

Multiple Day Event – Dates and Hours Required for each day of function (include set up and pack up times) Please include times, e.g. 1st February-10am – 11am. 1st of March- 10am-11am

Expected Attendance Numbers*

I/we agree to indemnify Presbyterian Church (for Presbyterian Hall) and Blackheath Area Neighbourhood Centre against any claims caused by negligence of the hirer in connection with the use of occupation of the premises and this indemnity shall not apply to negligence of the Presbyterian Church, or Blackheath Area Neighbourhood Centre.*

First Name of Responsible Party*

Last Name of Responsible Party*

Street Number & Street Name of Responsible Party*

Suburb of Responsible Party*

State of Responsible Party*

Postcode of Responsible Party*

Contact Number of Responsible Party*

Date Submitted*

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