Facility Booking Application Form
Created 07/16 1
Facility Booking Application Form
Please complete the form below and email to info@codc.govt.nz or deliver to your local Service Centre. Please
note that the booking is not confirmed until written confirmation from Council has been made.
Main Contact Details
Name: __________________________________________________ Phone: _____________________________
Email: ______________________________________________________________________________________
As the appointed adult (over 18 years) I accept responsibility for the venue hire. I have received, read, and
agree to the Terms and Condition relevant to the hire venue.
Signature: _______________________________________________ Date: ______________________________
Invoice Details
Name/Organisation ___________________________________________________________________________
Address ____________________________________________________________________________________
Phone ___________________________________
Non-Profit Local Sporting Group
Bank account number (if bond required) ___________________________________________________________
Event Details
Name of Event _______________________________________________________________________________
Sports Club Local User Group Community Committee Meetings Wedding
Funerals Ball ANZAC/ Commemorative Occasion Birthday Celebration
Exhibition/Show/Performance Other
Details of Event ______________________________________________________________________________
Estimate number of people _______________
Alcohol Provided Alcohol being sold
Decorations (please detail below) Equipment to be brought in (i.e BBQ, Heating. Please list below)
Additional notes: ______________________________________________________________________________
Booking Details
One off Booking Start Date: ____________________________________ Time: ____________________
End Date: _____________________________________ Time: ____________________
Ongoing Booking Start Date: ____________________________________ Time: ____________________
End Date: _____________________________________ Time: ____________________
Day of the Week: _____________________ Start Time: ____________________ End Time: ________________
Day of the Week: _____________________ Start Time: ____________________ End Time: ________________
Day of the Week: _____________________ Start Time: ____________________ End Time: ________________
Please note the following:
Current fees and charges can be viewed online at www.codc.govt.nz. Charges are advised prior to
confirming any booking
Please ensure that if alcohol is being provided or sold that you adhere to licensing rules and be a
responsible host. For further information see www.codc.govt.nz/services/alcohol-licensing.
Should your event present high risk, you may be required to present a health and safety plan to be
approved by Council.
Please advise immediately if you are cancelling any of your bookings. You may be charged if booking is
not cancelled.
click to sign
click to edit
Facility Booking Application Form
Created 07/16 2
Venue Required
Please refer to maps located in the terms and conditions of each venue to outline areas described below:
Alexandra Community Centre
Hall & Bar Reading Room Jordan Lounge Kitchen Crockery
Chair hire only No. required ________ Table hire only No. required ________
Alexandra Memorial Theatre
Heating Baby grand to be moved to the stage
Alexandra Service Centre (William Fraser Building)
Chambers Bill McIntosh Room Alexandra Conference Room
Tea Making Facilities Required No required ________
Cromwell Memorial Hall
Hall Supper Room Kitchen Crockery No required ________
Cromwell Service Centre
Chambers Tea Making Facilities Required No required ________
Maniototo Stadium
Stadium Stadium toilets/changing room Stadium Trestles (locked) Chairs
External Changing Rooms Kitchen Bar Club Rooms
Club Room Toilets Frost Cloth
Please note If booking the Club room for weekend use during Rugby Club season (end of March through to mid August), the user
contacts the Rugby Club directly to enquire if the Rugby Club are prepared to move any potential home game to the alternative venue
at Gimmerburn. If the Rugby Club agree then the user notifies Ranfurly Service Centre to confirm booking.
Molyneux Stadium
Stadium & Entrance Toilets Kitchen Change Room 1 Change Room 2
Change Room 3 Change Room 4
Please note that heating in this complex is user pays. Gas ceiling heaters take tokens sold at the Alexandra Service Centre $7 for 20
minutes. Electric wall heaters use 50c coins for 15 minutes.
Naseby Town Hall
Hall Kitchen Supper Room Stage
Ranfurly Town Hall
Hall Foyer Kitchen/Supper Room Back Stage and Changing Room
Roxburgh Service Centre
Hall Kitchen Chambers Tea Making Facilities Required No required ________
Roxburgh Entertainment Centre & Town Hall
Hall Supper Room Kitchen Theatre
Supper Room Track Spot Lights Hall Track Spot Lights
Wallace Memorial Meeting Room and Toilets
Waipiata Hall
Hall Supper Room
Office Use Only:
Cost of Hire: $ _________________________ Bond $ ___________________________________________
Debtor No ____________________________ Cleaner/Care taker notified COM file
Risk level assessed. If high risk contact has been made with the Council’s Health & Safety Officer
Date Booking Confirmed: ________________ Confirmed by: ______________________________________