Aboriginal and Torres Strait Islander people are warned that this website may contain images and voices of deceased persons.

I want to

Updates (6)

SEARCH

Aboriginal and Torres Strait Islander people are warned that this website may contain images and voices of deceased persons.

Cockburn Health and Community Facility Application for Hire Form

Print Form

Cockburn Health and Community Facility - Application for Hire form

All fields are required except where indicated

1. Details of Hirer

Title (select from the drop box below - optional):

First name:

Surname:

Company/Organisation:

Landline (e.g. 08 9500 1234 - optional):

Mobile (e.g. 0400 123 456):

Email:

Postal Address:

Enter the address

Number

Street

Suburb

State

Postcode

2. Details of Booking

Please add your booking days/dates to the fields below
If booking multiple dates press ‘Add new date’ for each booking.
NB: A maximum of ten bookings can be made at one time, for example once a week for ten weeks, once a month for ten months.

Day	Date	Start Time	End Time	Actions
Day	Date	Start Time	End Time
Add new date

3. Rooms required

NB: Conference Room bookings can include Community Room use for no extra cost. Please make sure to select both if this is a requirement.

Community Room (includes Kitchen facilities)

Occupancy: Currently 50 people max

$50.00 Per hour

Conference Room

Occupancy: Currently 100 people max

$100.00 Per hour (max 4 hours)
$700.00 Full Day (max 10 hours)

Will alcohol be consumed onsite?:

Yes
No

4. AV and Equipment

AV Equipment Hire:

Laptop with HDMI Cable and Clicker
Laptop with Clickshare and Clicker
Whiteboard markers
HDMI Cable
Handheld microphone 1 (Not available in Community Room)
Handheld microphone 2 (Not available in Community Room)

AV Equipment hire is included in room hire fees and charges

Approximate number of people attending:

Purpose of hire:

EG: Meeting, Workshop, Conference

5. Invoicing requirements

Please provide your ABN number if applicable:

For City of Cockburn Departments, please provide your Budget Number instead

6. Signature

I/We hereby acknowledge having read the Terms & Conditions of Hire and agree to ensure compliance with the fees and conditions therein

View the Terms and Conditions

Contact

Telephone: 08 9411 3444
CoSafe: 1300 26 72 33
Email: customer@cockburn.wa.gov.au
National relay service: 13 36 77
(ask for 08 9411 3444)
ABN number: 27 471 341 209

Address

City of Cockburn
Whadjuk Boodja
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

Language Support

Fire Danger Rating

Social Media

Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaditj boodjar kep wer kaadidjiny kalyakool yoodaniny, wer koora wer yeyi ngalak Birdiya koota-djinanginy.

The City of Cockburn acknowledges the Nyungar people of Beeliar Boodjar. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to Land, Waters and Culture and pay our respects to Elders, past and present.