County of Brant Floor Request

Name (First and Last)

Organization/Department

Address (Street address, P.O. Box, R.R. #, Apt/Suite)

City

Postal Code

Phone Number (s)

Email

Secondary Contact

Yes

No

Adult or Youth Group

Youth

Adult

Both Adult and Youth

Are you a League?

Yes

No

Pick the facility you would like to book:

Burford Community Centre (Spring/Summer season only)

Gaukel Memorial Community Centre (Spring/Summer season only)

Please provide first date of season required

Please provide last date of season required

Please note any dates not required during season, including statutory holidays

Please note the day of the week and times for each date you are requesting. eg. Burford Community Centre, Mondays 5:30pm-7:30pm

Is your activity a contact sport?

Yes

No

Expected Attendance

Does your group have accessibility requirements?

Yes

No

Liability insurance is mandatory for all rentals at County of Brant facilities at an additional cost. Please let us know which insurance you would like to purchase. If you are part of a sports association (ex. Hockey Canada) you must provide your own.

Yes, $2 million

Yes, $5 million

No, will provide own certificate of insurance

Please provide any additional information about your event/function

Please provide your signature

Clear