Seasonal Application Form

Club Details

Name of Organisation (Required)

Activity (Required)

Postal Address (Required)

Email Address (Required)

President Details

Name (Required)

Address (Required)

Phone Number (s) (Required)

Work Home Mobile

Secretary Details

Name (Required)

Address (Required)

Phone Number (s) (Required)

Work Home Mobile

Treasurer Details

Name (Required)

Address (Required)

Phone Number (s) (Required)

Work Home Mobile

Sports Ground Representative Details

Name (Required)

Address (Required)

Phone Number (s) (Required)

Work Home Mobile

Building Maintenance Representative Details

Name (Required)

Address (Required)

Phone Number (s) (Required)

Work Home Mobile

Player/Team Details

To be confirmed in writing after player registration day

Juniors

Total Number of Players

Seniors

Total number of players

I request the usage of the following Reserve(s)

Please indicate which you are requesting as backup reserves

Reserve Name/Field (Required)

Day (Required)

Please state what times you require the reserve(s) (Required)

For Example: Monday 3.30pm - 5.00pm

Please state how many senior and junior players will be present at each time slot (Required)

For Example: Monday 3.30pm -5.00pm 12 Juniors and 25 Seniors

If you are requesting the use of more than one reserve please continue, if not please skip to Special Events Section

Reserve Name/Field

Day

Please state what times you require the reserve(s)

For Example: Monday 3.30pm - 5.00pm

Please state how many senior and junior players will be present at each time slot

For Example: Monday 3.30pm -5.00pm 12 Juniors and 25 Seniors

Reserve Name/Field

Day

Please state what times you require the reserve(s)

For Example: Monday 3.30pm - 5.00pm

Please state how many senior and junior players will be present at each time slot

For Example: Monday 3.30pm -5.00pm 12 Juniors and 25 Seniors

Reserve Name/Field

Day

Please state what times you require the reserve(s)

For Example: Monday 3.30pm - 5.00pm

Please state how many senior and junior players will be present at each time slot

For Example: Monday 3.30pm -5.00pm 12 Juniors and 25 Seniors

Special Events

Reserve Name/Field

Date (s)

Time (s)

Purpose

Special Events

Reserve Name/Field

Date (s)

Time (s)

Purpose

Special Events

Reserve Name/Field

Date (s)

Time (s)

Purpose

Grounds Required

Dates (Required)

From x/x/20xx to x/x/20xx (inclusive)

Terms and Conditions (Required)

Indemnity (Required)

1.In consideration of Council approving your application for hire, the hirer indemnifies  the Council and agrees to keep it indemnified from and against all loss, damage costs and all expenses suffered or incurred by the Council by reason of:

(a)any breach of non performance of any terms and conditions that the hirer is required to observe and perform; and
(b)any act or omission on the part of the hirer that leads to a liability to a third party on the grounds of public liability for negligence or contributory negligence by the Hirer not including any act or omission by the Council, it’s Officers, agents, contractors or the like.

2. For the purposes of this Indemnity, “Hirer” will include any person to whom use is allowed in respect of the hirer approval.
3. This Indemnity shall be absolute and unconditional in any and all circumstances.
I have read and agreed to the Indemnity and conditions stated. It is recommended that the Public Liability Policy be a minimum of ten million dollars ($10,000,000),
City of Melville must be indemnified on said policy. A certificate of currency to be forwarded for approval to be granted. The indemnity referred to above is effective notwithstanding that the party claiming the loss, damage, charge, liability, outgoing, payment, expense or cost may not have been at or on the facility by the invitation or knowledge of the Hirer. The Hirer shall not commence any action, notice, demand, proceeding or make any claim of whatsoever nature against or to the Council and shall not hold the Council liable for any loss, damage, charge, liability, outgoing, payment, cost or expense in relation to the hire or use of the facility.

Hirer Accepts Terms and Conditions (Required)

Yes
No

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Seasonal Application Form

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