Oldbury Wells School Lettings Application Form

Name of applicant *

Name of organisation

Address

Contact numbers *

Date of hire *

Start Time *

End Time *

Proposed Venue(s) *

Additional facilities required

Email Address *

If you require a licence please agree

I hereby acknowledge that as Hirer, I am responsible for the making of all arrangements with the Performing rights Society Limited and if records are replayed, also with Phonographic Performance Limited for obtaining licences and for paying royalties in respect of works performed. I hereby undertake to indemnify the school against any actions or claim in respect thereof. I also agree to provide evidence upon completion of my booking form that I have made the appropriate arrangements in this regard.

Details of music to be played

If you are using any electrical equipment as part of your letting please complete

Details of any electrical equipment you wish to use during your hire:

Up to date test information (please provide evidence)

Details of electrical item that require testing

Your electrical equipment must be tested if not up to date. If you require testing to be carried out please provide details below. The charge is £5.00 per item and will added to your fees.

Child Protection - Your Responsibility

Name of designated person for CP

Address and contact number

Terms and Conditions of Hire

I agree to conform to the conditions outlined in the Terms and Conditions for Child Protection