BHCC Scheduled Activity Application Form – The Briar Hill Community Centre

(Use this form to apply to the BHCC for space and time for a new Scheduled Activity. If in doubt, please contact the BHCC Office.)

Date/Time Application was Submitted *

Date

Time

Activity Name *

(Ladies / Men / Mixed) *

Activity Description *

Start Date & Time *

Date

Time

Day of the Week *

Frequency *

Specify for "Other"

End Date / Time - or "Continuing"

Date

Time

Approximate number of Participants *

Participants Registered?

Drop-In? *

Room Selection(s)

Great Room Occupancy 345
Patio
East Room Occupancy 95
Lobby/Standing Occupancy 230
Lounge/Library Occupancy 38 (Drop-In Only. Not Available for Advance Booking.)

Lower Level Occupancy 198

Games
Centre
Card Area

Notes: (Description for eNews; Holiday exclusions for Calendar; etc.)

Instructor Hired? (Yes/No)

Fee being Paid per Session:

Fee Collected per Attendee:

Instructor Contact Information:

First

Last

Phone

Email:

Briar Hill Resident?

Additional BHCC Equipment Requirements

Audio / Visual
Projector
Games Equipment

Note: If you require any Audio-Visual equipment, you must meet with the Director of AV - scheduled through the BHCC Office.

Coordinator Contact Information: *

First

Last

Email *

Phone

Phase: *

WAIVER/EXCLUSION OF LIABILITY:

Briar Hill Community Centre Corporation, its employees, representatives and volunteers cannot be held responsible for any liability connected with participation in activities offered at the BHCC. Participants do so at their own risk for injury or damages.

Note:

Please print a copy of your completed form for your records.

Remember to use the PRINT PAGE button below to print the form, before using the SUBMIT button.