Cockburn Health and Community Facility Application for Hire Form

Print Form

Cockburn Health and Community Facility - Application for Hire form

All fields are required except where indicated

1. Details of Hirer

2. Details of Booking

Please add your booking days/dates to the fields below
If booking multiple dates press ‘Add new date’ for each booking.
NB: A maximum of ten bookings can be made at one time, for example once a week for ten weeks, once a month for ten months.

3. Rooms required

NB: Conference Room bookings can include Community Room use for no extra cost.  Please make sure to select both if this is a requirement.

Occupancy: Currently 50 people max
  • $50.00 Per hour
Occupancy: Currently 100 people max
  • $100.00 Per hour  (max 4 hours)
  • $700.00 Full Day (max 10 hours)
Will alcohol be consumed onsite?:

4. AV and Equipment

AV Equipment Hire:

AV Equipment hire is included in room hire fees and charges
EG: Meeting, Workshop, Conference

5. Invoicing requirements

For City of Cockburn Departments, please provide your Budget Number instead

6. Signature

View the Terms and Conditions

Related Pages



City of Cockburn
Whadjuk Boodja
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

Language Support

Social Media

Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaadatj dayin boodja, kep wer malayin. Ngalak kaadatj koora koora wer yeyi ngalang birdiya.

City of Cockburn acknowledges the Nyungar people of Beeliar boodja. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to land, waters and culture and pay our respects to the Elders, past and present.