SHEDFIELD READING ROOM

BOOKING FORM

To be submitted to: the Booking Secretary, Windmill House, St John’s Lane, Shedfield. SO32 2TA

Cheques: One for hire and one for the deposit, made payable to Shedfield Reading Room. All cheques will be banked.

DETAILS OF APPLICANT

Name: ...................................................

Address: ..............................................................................................................

Contact Telephone Number: ................................................................................

DETAILS OF HIRE

Date(s): ..............................................................................................................

Time (to include setting up and clearing away)

: ....From: .......................To:...............

Type of Function: (e.g. children’s party) ............................................................

If music featured please tick option below

Concert	Pantomime	Keep Fit	Recital
Dance	Disco	aerobics & dance classes	Socials, bazaars etc with music

Other (Please state) ..................................

Numbers: Please give estimate of numbers taking part ................................

State Pensioners: Please tick if function is for State Pensioners only

Alcohol Licence:

(Please tick option) Not Applicable Applied For

UNDERTAKING

I agree to abide by the Terms and Conditions of Hire of Shedfield Reading Room.

I also agree to ensure that should any persons under the age of 18 years be present, they will be supervised in the ratio of at least one adult to every 15 persons under the age of 18 years.

Signature .................................................. Date ................................