<p> Phoenix Youth Hub Booking Form</p><p>All bookings are subject to the conditions of use outlined in this form. It is the hirer’s responsibility to ensure they understand and comply with the conditions of use.</p><p>Event/Booking Name:</p><p>Organisation / Business name:</p><p>Contact name:</p><p>Contact Number:</p><p>Email:</p><p>Address:</p><p>Not for Youth Community Hirer category: profit: Focus: Group</p><p>Booking Date: Booking Start Time Booking End Time (Bump In) : (Bump Out) :</p><p>Spaces required: Auditorium Courtyard & BBQ area</p><p>Art Studio Meeting Room 3 Bunker Community Kitchen & Multispace Training Room</p><p>Additional comments or conditions (Office Use Only): Purpose of Booking: Please provide a brief description of the content</p><p>Food & Drink: Will there be food and drink at the activity? If yes please provide details e.g. Refrigeration required</p><p>Public Liability Insurance:</p><p>All hirers must hold public liability insurance to the value of $10 million. A copy of the policy must be attached to the booking form and the details completed below. Young people and not for profit groups can purchase public liability insurance through Council for $25 per use.</p><p>Public liability insurance policy: Details provided below / purchase through (please circle) Council Name of Insurance company: Policy Number: Amount of Cover: Expiry Date:</p><p>Please attach a copy of your Public Liability Certificate </p><p>Bond & Hire Cost: Booking bond Swipe card bond Total bond payable:</p><p>Room booking fee Public liability insurance fee Cleaning Fee Total Hire Fee payable:</p><p>Payment Method: Cash EFT Invoice Optional Survey: Would you be interested to complete a short and confidential survey post booking? If yes, please tick the box.</p><p>The information gathered will help us to see what we are doing well and where we need to improve. All information gathered is confidential, and hirers can remain anonymous if they choose.</p><p>Hire Agreement:</p><p>The /Hirer shall indemnify and keep indemnified Maribyrnong City Council, its servants and agents and each of them from, and against, all actions, costs, claims, charges, expenses and damages whatsoever, which may be brought or made or claimed against it by any of them arising out of, or in any way related to, the granting of this agreement and/or the use of the premises. The Hirer’s liability to indemnify Maribyrnong City Council will be reduced proportionally to the extent that any act or omission of Maribyrnong City Council, its servants or agents, contributed to the loss of liability.</p><p>I acknowledge having received a copy of the conditions of hire, and undertake, on this application being accepted, to comply in all aspects to such conditions.</p><p>I consent to my contact details being provided to Council’s security contractor to assist with security and access issues arising from my booking.</p><p>Name of Hirer:______Date ___/____/_____</p><p>Signature of Hirer: ______</p><p>Booking approved by Staff Member:______Date ____/____/______</p><p>Privacy Statement: The personal information collected by Council is used for municipal purposes as specified in the Local Government Act 1989. The personal information requested on this form is being collected by Council for reference and identification, mailing purposes, or related purposes. Council may disclose this information to other organisations if required by legislation. The Hirer understands that the personal information provided is for the above purpose and that he/she may apply to Council for access to and/or amendment of the information. Requests for access and/or correction should be made to Council’s Privacy Officer.</p>