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Mackay Regional Council
Andergrove Community Hall
Contact details
Organisation or hirers' name:
ABN if applicable:
Contact name:
Postal address:
Phone number:
Mobile phone number:
Email address:
Drivers licence:
Event details
Event name:
Party Safe registration number:
https://forms.police.qld.gov.au/launch/eventpartysafe
Hall name:
Andergrove Community Hall
Area within hall:
Foyer
Meeting room
Hall
Kitchen
Locker
Whole facility
Type of event:
Public
Private
Charitable/Fundraiser
Anticipated number of attendees:
Less than 50
51-200
Event overview:
Type of hire:
Casual hire
Regular hire
Fill out for casual hire
Have you filled out the Liability Insurance Acknowledgement and Declaration Form?
Document above 'Casual hire liability insurance acknowledgement form'
Yes
No
Upload your signed Liability Insurance Acknowledgement and Declaration Form
Hire commencement:
End of booking:
Booking start time including setup:
Booking end time following pack down:
Do you intend to construct or bring into the facility a platform, stage or any other type of equipment?:
Yes
No
If yes, upload diagram of where the equipment will be located within the facility
If yes, list the size of the egress and ingress around any platform or stage you will be installing (Description, dimensions, weight, floor protection)
Please note any extra electricity requirements:
Will you have security employed during this event?:
Yes
No
Company hired:
Contact number:
Company certificate of currency:
Ratio of security to patrons:
Will you be hiring a catering company?
Yes
No
Company hired:
Contact number:
Company certificate of currency
Will you be selling alcohol at the event:
Yes
No
Upload service of alcohol permit and or liquor licence
Fill out for regular hire
Your company certificate of currency
For regular hire, choose how frequently
Daily
Weekly
Monthly
Preferred days?
Monday
Tuesday
Wednesday
Thursday
Friday
Sunday
Notes:
(e.g.: hire will be the 3rd Friday of the month and every 2nd Saturday from 9/10/2021)
First hire date:
Last hire date:
Start time (include set up time):
End Time (include pack down time):
I acknowledge having received and read a copy of the ‘Community Facilities Terms and Conditions of Hire’ and undertake to be bound by and comply with these Conditions in every respect, including any legislative or health directives imposed by the State Government and Fire Safety Regulations (item 9)
Yes
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