Name of Group

Contact Person

Email Address

Phone

Please briefly describe the program/activities you would like to run:

What day(s) and times are you looking to use the building?

Do you have your own public liability insurance? Do you have your own public liability insurance? Yes No

Do you commit to following the HSE’s public health guidelines regarding COVID 19? Do you commit to following the HSE’s public health guidelines regarding COVID 19? Yes No

Are you working with children? Are you working with children? Yes No

If working with children, can you confirm you have a Child Safeguarding Policy and that all volunteers are Garda vetted? If working with children, can you confirm you have a Child Safeguarding Policy and that all volunteers are Garda vetted? Yes No

Please tick confirm that you have read, understand and commit to abide by the Church of the Nazarene Greystones Building Usage Policy Please tick confirm that you have read, understand and commit to abide by the Church of the Nazarene Greystones Building Usage Policy Please tick confirm that you have read, understand and commit to abide by the Church of the Nazarene Greystones Building Usage Policy

Additional notes or queries (optional)