Seasonal Hire Application Form

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Association/Club Name*

Purpose of Hire*

Street Address / PO Box:*

City / Town:*

State:*

Post Code:*

Country:*

All Hirers must have public liability insurance to the value of $10 million. The insurance must note the ToPH as an interested party. Hirers must provide the ToPH with copies of their current insurance policy at the time of making this application. Sports groups may be able to obtain this insurance certificate from their State Sporting Association.

Please attach a copy of your Public Liability Insurance Policy*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Please attach a copy of your Game Plan Registration*

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Number of Teams

Will You Have Senior Teams?*

YesNo

Will You Have Junior Teams?*

YesNo

Membership Numbers

Will You Have Senior Members?*

YesNo

Will You Have Junior Members?*

YesNo

Will You Have Social Members?*

YesNo

Total Expected Members*

Committee

All seasonal correspondence will be communicated with the primary and secondary contacts for dissemination to the committee members.

Please provide as much accurate information as possible regarding your committee contacts.

Primary Contact*

Secondary Contact (must be different from primary contact)*

President:

Name*

Best Contact Number*

Email*

Vice President:

Name*

Best Contact Number*

Email*

Secretary:

Name*

Best Contact Number*

Email*

Treasurer:

Name*

Best Contact Number*

Email*

Registrar:

Name*

Best Contact Number*

Email*

First Committee Member:

Name

Best Contact Number

Second Committee Member:

Name

Best Contact Number

Third Committee Member:

Name

Best Contact Number

Please select the applicable facilities below

Seasonal Requirements

Before submitting this application, please ensure you have completed all items on the check list below

Booking Confirmation

No booking will be confirmed until the completed application form and required documentation has been submitted and assessed by the ToPH, and the appropriate hire fee and bond have been paid. If the booking is accepted, the ToPH will issue a Confirmation Letter to the hirer.

Please be aware all bookings are subject to change. Special events and finals may require adjustment to seasonal bookings. This will only occur following consultation with all groups involved.

Refusal or Termination of Booking

The ToPH reserves the right to refuse any application. Failure to comply with requirements set out in this document will be regarded as a breach of the hire agreement, giving the ToPH the right to recover any amount due in respect of such breach and/or cancel any future bookings. The ToPH reserves the right to determine the cost of any damage/s and/or extra cleaning.

Declaration, Acknowledgement & Acceptance of Terms and Conditions of Hire

By submitting this form, for and on behalf of the Club/Association, you acknowledge and agree with the following:
Maintain the appropriate authority to form an agreement on behalf of the Club/Association
I/we agree the information provided is true and correct
Club/Association is required to comply with the Town of Port Hedland's (i) Facility Hire Terms and Conditions, as well as (ii) Seasonal Hire Policy.

Full name of authorised representative of Club/Association*

Position*

Date*

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