I wish to hire (please tick) Wongawilli Community Centre    

Please note that application to the Dapto Rural Fire Service (ph 4261 7363 - fax 4261 7279) is required for the use of the Park Grounds surrounding the Hall. The boundary of the Hall is the toilets and the concrete slab at rear.

I will require kitchen facilities?            Yes              No

Date of Event: ______________________________________________________________________________

Time: (including preparation & cleaning time)   From _______________ to . _______________

Type of Event:  _____________________________________________________________________________

Number Attending Function (approx.) ____________ but will not exceed ____________________

Name of Hirer: __________________________________________________________________________

Address:         __________________________________________________________________________

Suburb:           _____________________________________  Postcode:  ________________________

Telephone No  (     ) _________  (W)   (     ).__________  (H)   Fax No.  (     ).__________________

Please note that you or your organisation may be liable for any loss, damage or claims resulting from your use of this facility.  You should consider obtaining suitable insurance.

I have read the conditions applying to the use of the Centre.  I agree to abide by and be bound by those conditions.

Please note all rubbish is to be taken away or a fee of $25 can be paid for use of the Hall Bin.

Enclosed :                  $ _________ full hiring charge,  $ _________ deposit,

                                   $ _________ bond,  $ 25 Hall Bin Fee

(Delete whichever not applicable)

Total Enclosed:          $ __________

Date _____________________  Signature._____________________________________

Please return form to:       

Wongawilli Colonial Dance Club Inc.

PO Box 175, Jamberoo, NSW, 2533

Enquiries:     David De Santi desanti@bigpond.com  or tel: 0409 57 1788