Online Form - General Bookings Application Form Your Details Name of organisation: * Primary Contact Name: * Email: * Mobile: * Street Address: Suburb State: Post Code: Country: Select Country >> AUSTRALIA -------- AFGANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTIGUA & BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BONAIRE BOSNIA & HERZEGOVINA BOTSWANA BRAZIL BRITISH INDIAN OCEAN TER BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHANNEL ISLANDS CHILE CHINA CHRISTMAS ISLAND COCOS ISLAND COLOMBIA COMOROS CONGO COOK ISLANDS COSTA RICA COTE DIVOIRE CROATIA CUBA CURACO CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TER GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREAT BRITAIN GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUYANA HAITI HAWAII HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISLE OF MAN ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA NORTH KOREA SOUT KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAYSIA MALAWI MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MIDWAY ISLANDS MOLDOVA MONACO MONGOLIA MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMBIA NAURU NEPAL NETHERLAND ANTILLES NETHERLANDS NEVIS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORWAY OMAN PAKISTAN PALAU ISLAND PALESTINE PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILLIPINES PITCAIRN ISLAND POLAND PORTUGAL PUERTO RICO QATAR REPUBLIC OF MONTENEGRO REPUBLIC OF SERBIA REUNION ROMANIA RUSSIA RWANDA ST BARTHELEMY ST EUSTATIUS ST HELENA ST KITTS-NEVIS ST LUCIA ST MAARTEN ST PIERRE & MIQUELON ST VINCENT & GRENADINES SAIPAN SAMOA SAMOA AMERICAN SAN MARINO SAO TOME & PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SPAIN SRI LANKA SUDAN SURINAME SWAZILAND SWEDEN SWITZERLAND SYRIA TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TOGO TOKELAU TONGA TRINIDAD & TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS & CAICOS IS TUVALU UGANDA UKRAINE UNITED ARAB ERIMATES UNITED KINGDOM UNITED STATES OF AMERICA URAGUAY UZBEKISTAN VANUATU VATICAN CITY STATE VENEZUELA VIETNAM VIRGIN ISLANDS (BRIT) VIRGIN ISLANDS (USA) WAKE ISLAND WALLIS & FUTANA IS YEMEN ZAIRE ZAMBIA ZIMBABWE Booking Details Please provide as much detail as possible to help us plan for your event. For multiple bookings, please provide further details to bplc.bookings@vincent.wa.gov.au once you've submitted this form. Type of booking * Select an Option Commercial Community (not for profit) Internal Type of booking * Select an Option Commercial Community (not for profit) Internal Is your booking.. (please select) * Select an Option Daily Weekly Monthly School term Yearly Carnival Other One off Will your booking continue through school holidays? YesNo Will your booking continue on public holidays? YesNo Please Note: The centre hours may be affected by public holidays. Estimated Swimming Attendance (Adults over 16) Estimated Swimming Attendance (Children 5-15 years) Estimated Spectators (Not Swimming) Payments Students aged over 16 and concession cardholders will need to show valid ID for discounted entry. Please view our entry fees here. Invoice required? YesNo Please provide a name and email address : * Entry fees to be included on the invoice YesNo We will finalise all payments on the day (a receipt will be provided for payments made on the day) YesNo Swimmers will pay their own entry on the day YesNo Pool Hire If you are not booking pool space, please ignore this section. Please note, carnivals can only be booked on Wednesday, Thursday and Friday during Term One of each school year. Purpose of booking: (please specify): Booking start date: Booking end date: Booking start time: Booking end time: Dates to be excluded from regular booking: 50 metre Outdoor Pool: Number of lanes required Select an Option 0 1 2 3 4 5 Entire Pool (Carnivals Only) 30 metre Outdoor Pool: Number of lanes required Select an Option 0 1 2 Half Pool Full Pool 12 metre Outdoor Pool: Space required Select an Option Not Required Half Pool Full Pool 6x3m Shade Shelters required? (additional charges apply) Select an Option 0 1 2 3 4 5 6 7 8 Number of tables required (up to 8) Number of chairs required (up to 50) 25 metre Indoor Pool: Number of lanes required Select an Option 0 1 2 3 4 5 Indoor Pool Leisure Areas required LagoonSlide poolBeach rock poolGeneral leisure swim Lane ropes required? YesNo Dedicated lifeguard/s required? YesNo Additional charges apply. PA system required? (carnivals only) YesNo Room Hire If you are are not hiring any rooms, please ignore this section. Booking start date Booking end date Booking start time Booking end time Rooms required Club RoomClub Room & Outdoor BBQCycle StudioStudio 2 (subject to availability) Number of chairs required (up to 50) Number of tables required (up to 8) Whiteboard required? YesNo Projector Hire YesNo Additional Requirements Do you require a repeat booking? Select an Option Daily Weekly Fortnightly Monthly Other If other, please specify Please advise if you have any other requirements. Terms & Conditions We require all hirers to have Public Liability Insurance. Please read our Conditions of Hire before submitting this form. I am over 18 and have read, understood and agree to the Terms & Conditions: * I agree If you have it now, please attach your Public Liability Insurance documentation Maximum size of ALL attachments is 976.56 MB Type the code from the image: Get Audio CodeType the code from the image