Application to book community facility
Please read this first
This form will be scanned by electronic equipment. It is important that you:
use a blue or black pen to complete this form; and
print clearly.
Office use only
Cleaner advised? NAR
Booking entered?
Date entered
/ /
2 0 Amount paid
tararua district council
26 gordon street
po box 115
dannevirke 4942
06 374 4080
Applicant details (Please print in CAPITALS)
Name of organisation or individual
Contact person
Daytime phone number Afterhours phone number Mobile number
Facility details (Please print in CAPITALS)
Purpose the facilities are being used for
Which facilities do you want to book?
Dannevirke Sports Centre
Stadium Boxing room Supper room Kitchen
Eketahuna Community Centre Eketahuna War Memorial Hall
Pahiatua Town Hall
Main hall Supper room Kitchen Heating
Woodville Stadium
Stadium Supper room Kitchen
What time and dates do you want to use the facilities? (If you are booking the facilities for a season, use A. If this is a one-off
booking, use B.)
Day of week (e.g. Monday)
Start time Finish time
/ /
2 0
Start date
/ /
2 0
Finish date
Day of week – in (e.g. Saturday)
/ /
2 0
In time In date
Day of week – out (e.g. Sunday)
/ /
2 0
Out time Out date
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Payment details (Please print in CAPITALS)
Paying by cash/cheque/eftpos
Send invoice to:
Postal address
Town Postcode
I wish to apply for the use of the above indicated sports facilities and agree to accept liability for any damage incurred during the
period of hireage.
I agree to leave the hall in a clean and tidy condition.
I have read and signed the Tararua District Council Building Hire Fire Evacuation Information.
/ /
2 0
Signature of applicant Date
click to sign
click to edit