Contact Person Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact number *

(###)

###

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Desired Date

MM

DD

YYYY

From *

Desired Time

Hour

Minute

Second

AM PM

To *

Hour

Minute

Second

AM PM

Desire Rooms & Equipment *

Area 1: Counselling & Meeting Rooms, Kitchen, Toilets

Area 2: Small Hall, Toilets, Playground

Area 3: Café / Foyer area (no auditorium)

Auditorium with Café & Foyer

Auditorium with Foyer Only

Living Room

Audio Visual Facilities Required

For auditorium hire, a media tech and sound tech is required and fees payable dependent on the specific requirements

Audio PA

Video & screens

Frequency of use

One-off

Weekly

Monthly

Do you have your own insurance? *

Yes

No