Community facility booking form - Ashfield Civic Centre and Haberfield Centre PLEASE NOTE: Applications must be made at least ten (10) business days before the requested event. Booking details Event/Activity Name* - required Requested Venue* - required [Please Select] Ashfield Activity Room 1 (Therese Heffernan Room) Ashfield Activity Room 2 (Patricia Blackman Room) Ashfield Activity Room 3 (Peter Cross Room) Ashfield Activity Room 4 (Irene Williams Room) Ashfield Town Hall – Main Hall Haberfield Centre - Michael Maher Room Haberfield Centre - Graham Yarroll Room Haberfield Centre Meeting Room 1 (Euphemia Ferrier Room) Haberfield Centre Meeting Room 2 (Thelma Hatfield Room) Marrickville Pavilion Learning Room 1 - Francis Charteris Marrickville Pavilion Learning Room 2 - Pauline McLeod Type of Event* - required No. of attendees* - required [Please Select] 0-9 10-20 21-30 31-49 50-99 100-149 150-200 Over 200 Organisation name (if applicable) Type of event (wedding, party, birthday etc) Additional description of activity Username (if you already have an existing profile in Council Activity details Day/s requested* - required Times (From/To AM/PM - You MUST include all time required to set up and pack up)* - required Contact person for general enquiries about the event* - required Contact number for general enquiries about the event* - required Activity start time* - required Activity end time* - required Is the activity open to the public?* - required [Please Select] Yes No Will you be utilising the facility for the purpose of commercial art auctions, markets, or retail sales?* - required [Please Select] Yes No Will amplified or live music be used during your booking?* - required [Please Select] Yes No If yes please give details Will you be providing services to children requiring compliance with the Child Protection (Working With Children) Act 2012?* - required [Please Select] Yes No If yes, you are required to be able to provide on request, all necessary clearances, permissions, certificates and permits as directed by the legislation. Failure to do so may result in Council cancelling the booking. Will you be serving food or engaging the services of a contractor to provide food services during your booking? (this includes temporary food stalls or mobile food vehicles)* - required [Please Select] Yes No If yes, you are required to ensure compliance with current Food Safety Standards, and if applicable, hold an appropriate Temporary Food Stall license issued by Inner West Council. Will you be engaging the services of a contractor to conduct activities on the premises during your booking?* - required [Please Select] Yes No If yes, you are required to obtain and provide to Council a copy of the contractor's Certificate of Currency for public liability insurance to the value of twenty million dollars. Please upload here. Will alcohol be sold at the facility during your booking?* - required [Please Select] Yes No If yes, you are required to obtain and provide to Council details of an appropriate license. Please upload here.. If yes, please provide the name of the delegated attendee with an RSA accreditation here. Will alcohol be served in the facility during your booking and will there be more than 12 persons present?* - required [Please Select] Yes No Participant details Proportion of participants that live in the Inner West Council area? (See suburbs below)* - required [Please Select] 10% or less Approximately 25% Approximately 50% Approximately 75% 100% *This includes the suburbs of Annandale, Ashfield, Balmain (including Balmain East), Birchgrove, Dobroyd Point, Dulwich Hill, Enmore, Haberfield, Leichhardt, Lewisham, Lilyfield, Marrickville, South Marrickville, Petersham, Rozelle, Stanmore, St Peters, Summer Hill, Sydenham, Tempe.Inner West Council also includes parts of Ashbury, Camperdown, Croydon, Croydon Park, Hurlstone Park and Newtown. Checkbox List* - required Activity not targeted: aimed at general population Aboriginal and/or Torres Strait Islander peoples Children 0 – 11 years Youth (12-24) Older people (55 years and over) Lesbian, gay, bisexual, transgender, intersex, queer communities Women People from culturally and linguistically diverse backgrounds People with a disability Residents of boarding houses People who are homeless Other Other Is the activity free to participants?* - required [Please Select] Yes No If no, what is the cost per person per session?* - required [Please Select] Free Under $5 $5- $10 $11- $15 $16- $20 Over $20 What approximate proportion of your participants hold low-income or pensioner Health Care Cards?* - required [Please Select] 10% or less Approximately 25% Approximately 50% Approximately 75% 100% Do you offer concession/lower fees for people with a Health Care Card?* - required [Please Select] Yes No If yes, what is the cost per person per session?* - required [Please Select] Under $5 $5- $10 $11- $15 $16- $20 Over $20 Applicant details Organisation or hirer name* - required Contact name* - required Street Address* - required Suburb* - required Postcode Postal address (if different to street address) Phone number* - required Mobile* - required Email* - required Alternate contact for booking Email Mobile Phone number Contact name COVID Safety Plan ('CSP') A COVID Safety Plan (or 'CSP') must be submitted with your application. To make a CSP, follow the link below and answer each question/prompt.https://www.nsw.gov.au/form-master-page/covid-safety-plan/gyms-and-indoor-recreation-covid-19-safety-plan Once you have completed the online CSP form, a copy will be emailed to you by the website. Please attach a copy of the file below. NOTE: Our venues have QR codes that you may use with the NSW Health App for Guest Registering and Contact Tracing purposes. Upload your CSP here:* - required Further information Are you a sporting body, club, association or incorporated body?* - required [Please Select] Yes No Have you hired an Inner West Council facility more than 11 times this year?* - required [Please Select] Yes No Will you be hiring or have you hired an Inner West Council facility more frequently than once per calendar month?* - required [Please Select] Yes No Will you be utilising the facility for commercial of profit making purposes?* - required [Please Select] Yes No If you answered YES to any of the above questions, you are required to provide a copy of a valid Certificate of Currency as evidence of public liability insurance to the value of twenty million dollars. Please upload here. Invoicing details (if different to your details provided above) Organisation or hirer name Email Mobile Phone number Postal address Suburb Postcode Street Address Contact name Declaration I have attached a copy of my/our Certificate of Currency as evidence of public liability insurance if applicable.* - required I understand that information provided with this application (including the application form) and any subsequent information submitted as part of this application, may be disclosed under the provisions of the Government Information (Public Access) Act 2009 and correspondence from Council may be made available for viewing by the general public.* - required I have read and understand the Inner West Council Community Facilities Conditions of Hire.* - required NOTE: This system does Not issue confirmation emails - please allow 2-3 business days for this application to be processed; you will be contacted by the Venues Booking Team with further instructions. Mandatory field(s) marked with *
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