Thomson Street Netball Courts Application Form

Thomson Street Netball Courts
Application Form
City of Mandurah Recreation Services
3 Peel Street, Mandurah (PO Box 210)
Phone: 9550 3601
Email: [email protected]
Fax: 9550 3737
This form is an application only and must be submitted by the closing date listed below. Your booking is not approved until the City
of Mandurah are satisfied with all sections of the application and a confirmation letter is issued. Any late or incomplete application
may inhibit the chance of receiving the requested venues, times or dates.
NAME OF CLUB:
POSTAL ADDRESS:
Title
Name
Contact Number
Email Address
President
Secretary
Treasurer
Person Responsible for this booking:
Contact Phone No. (during business hours):
Email Address:
Dates required
Starting Date: _______________________
Finish Date: _________________________
Public Liability Insurance
( when completed)
Attach a copy of your current Public Liability Insurance cover with your application.
Facility Keys
 Please indicate which keys you require:
Building
Lighting
Electricity
Gates/Chains
 Number of Sets Required: ……………………. (no more than 3)
 If you are already in possession of keys, please complete the attached Key Register Form
Kiosk Requirements

Do you require the use of the Kiosk?
Start: ______________________ Finish: _____________________
COURTS REQUIRED (Please advise your preference) Refer Aerial Map Attached
Start
Time
Day
Finish
Time
Training/
Match
1
2
3
4
5
6
7
8
9
10
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please note that lighting will be charged from 5.30pm onwards
Declaration
I ........................................................
being the duly authorised representative of the applicant in
endorsing this application, accept full responsibility for the above booking and will ensure compliance with the
Booking Guidelines & Procedures, Conditions of Hire Agreement and Local Laws.
Signature: ................................................................................
[Type text]
Date:
........................................................
[Type text]
1
2
3
4
5
1
6
9
8
7
10
2