thr · web viewname organisation address contact number activity please give a brief...

NAME

ORGANISATION

ADDRESS

CONTACT NUMBER ACTIVITYPlease give a brief description of the activity you intend to deliver.

EQUIPMENT Please let us know if you need any additional equipment.

You will be provided with 1x Table and 2 Chairs.

Our Place Kings Norton need to take all practical steps to ensure that this event is a safe and rewarding experience for everyone. An important part of this commitment is a GOOD record of Health and Safety. To help us maintain our excellent record please can you complete the following questions. Do you have suitable insurance arrangements in place which cover your group/ organisation or company and any staff and volunteers ‘working’ at this event?

YES NO

While at this event do you intend to use any electrical appliances?

Will you ensure that all electrical appliances and leads are tested (PAT) before the event and provide proof if required? SIGNED DATE

WORK & LEARN DAY 2013BOOKING FORM

Wednesday 6th November, 11am – 2pm

Please return this form to lisa.opkn@gmail.com by Friday 1st November 2013.