Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Purpose of Hire
*
Party (aged 12 and below)
Activity (involving children aged 17 and below)
Other (please give details below)
Details of Hire
*
Which space are you hiring?
*
Hall
Room 1
Room 2
Room 3
Room 6
Room 7
Other
Date of hire
*
MM
DD
YYYY
Start time
*
This must include set-up time.
Hour
Minute
Second
AM
PM
Finish time
*
This must include clear-up time.
Hour
Minute
Second
AM
PM
Gift Aid
If I have ticked this box headed Gift Aid, I confirm that I am a UK Income or Capital Gains Taxpayer. I have read this statement and I want the charity Bedford House Community Association Reg 1178692 to reclaim tax on the membership fee, and on any additional donations. I understand that if I pay less Income Tax or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all of my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on every £1 that I have given.
I understand the cancellation terms.
*
The cancellation period is 21 days after your deposit has been taken. The cancellation fee for this period is £30. After 21 days your booking is non-refundable.
By ticking this box, I confirm that I am either a current member of Bedford House, or the £5 Space Hire membership fee is included in my quote.
*
I have read, understood, and agree to the BHCA Terms and Conditions of Hire.
*
I have read, understood, and agree to the General Fire Notice and Evacuation Plan, and will abide by these instructions.
*
I confirm that the hire and use of the building and facilities will not compromise the published objects of the charity.
*
I understand that BHCA reserves the right to retain the deposit as a result of improper use of the premises, damage to the facilities or reputation of the charity as a result of the hire, and /or failure to abide by the terms of the agreement and conditions of hire, including hire timings.
*
I confirm I have the appropriate Public Liability Insurance for this hire, and I have provided BHCA with a copy.
*
If you wish to engage a third party such as: a caterer, entertainer, sound system hire, party organiser, bouncy castle etc, you must provide BHCA with relevant and valid insurance as appropriate. N.B: The reason hirers must have insurance is that, if anyone has an accident or claim they have had an accident during the hire, the hirer may be held liable. BHCA DOES NOT ACCEPT LIABILITY FOR HIRERS' EVENTS. Hirers must therefore, take out the relevant event insurance as appropriate.
Disability
*
I consider myself to have a disability or learning difficulty.
I do not have a disability or learning difficulty.
Prefer not to say
Year of Birth
*
I give permission to BHCA to use photographs of me for publicity materials.
*
Occasionally we take photographs of activities to be used in our publicity materials.
Yes
No
How did you hear about us?
*
Word of mouth
Social Media
Internet search
Public Listing
Ethnicity
*
White: British
White: Irish
White: Gypsy or Irish Traveller
White: Other
Mixed/Multiple Ethnic Group: White and Black Caribbean
Mixed/Multiple Ethnic Group: White and Black African
Mixed/Multiple Ethnic Group: White and Asian
Mixed/Multiple Ethnic Group: Other Mixed
Asian/Asian British: Indian
Asian/Asian British: Pakistani
Asian/Asian British: Bangladeshi
Asian/Asian British: Chinese
Asian/Asian British: Other Asian
Black/African/Caribbean/Black British: African
Black/African/Caribbean/Black British: Caribbean
Black/African/Caribbean/Black British: Other Black
Other Ethnic Group: Arab
Any other Ethnic Group
I would rather not say.