K
O
Z
A
K
1ST Floor, 66 Orsmond Street, Hindmarsh
PO Box 42, Hindmarsh SA 5007
Phone/Fax: 08 8346 7339
Email: enquiries@theballroom.net.au
W: www.theballroom.net.au
ABN: 72827729498
VENUE HIRE BOOKING FORM
Event Booking Date
Day:
_________
Date: _________of_______________ 20______
Client Details
Name:__________________________________________________
(Mr/Mrs/Ms)
(First Name)
(Surname Name)
Name of Organisation (if applicable):_______________________________
Phone Home:
____________ Work __________Mobile__________________
Address:_________________________________________________
________________________________
P/C _________________
Email:__________________________________________________
B
A
R
Ukrainian Member Number: _______________ Expiry Date: ____________
Event Hire Details
Function Description: ________________________________________
Venue Opening time for Set-Up: ________am / pm No. of Guests: __________
(Access by the Hirer is not available prior to 10.00am on the day of the function)
Event Commencement Time: ______am/pm
*Departure time: _________am / pm
*Includes set-up and clean-up times, Departure time must not exceed 1pm
1
K
O
Z
A
K
B
A
R
Caterer Details
Caterer being Hire: Yes 
No 
*Name of Caterer:_____________________
Are barbecues or smoke machine being used? Yes 
No 
Location of barbecue/machine: _____________________________________
Venue Inventory
Below is a list of all furnishings and equipment included in the hire fee. It is the
responsibility of the Client to arrange for the hire of any additional items required.
Hall
Kitchen
Approx 80 padded chairs (black)
1 Electric Oven/Gas top Stove
30 Square Tables – 80cm x 80cm
1 Commercial Dishwasher
Air conditioning
1 Microwave oven
Carpet and Vinyl Floor
1 Domestic fridge
5 – Tall bar Tables with 12 Bar Chairs
1 Electric Urn
Products Available for Hire * Sound Equipment Hire: Yes 
No 
Capacity of Venue
Theatre style: 180
Cocktail style: 250
Formal sit down with dance floor: 100
Formal sit down without dance floor 150
Parking
Off street and Street parking available.
(Off street parking limited during Soccer Events held at the Hindmarsh Stadium)
2
K
O
Z
A
K
B
A
R
Liquor Licence (Client’s responsibility)
Required: Yes 
No 
*Please note: Liquor & Gambling Commission require a minimum of 14 working days
notice and may be applied for by completing an application via their web site, in person or, by
requesting an application by fax. Details as follows: Office of the Liquor & Gambling
Commissioner, 9th Floor, East Wing, 50 Grenfell St, Adelaide SA 5000
Phone: (08) 8226 8410
Fax: (08) 8226 8512
Email: olgc@agd.sa.gov.au
Web Site: www.olgc.sa.gov.au
Please note; you will require approval from the Association of Ukrainians in S.A. Inc / Kozak
Bar Clubroom to support your application when submitted.
*Liquor Licence not required for ‘serviced bar hire’ only.
PRICING FOR
2012
(place a tick next to the applicable hire)
KOZAK BAR ROOM HIRE ONLY
 Kozak Bar Venue Hire: $700.00 (includes the use of Kozak Room, kitchen & Foyer
area only plus a Care Taker for the duration of the function.)
 New Years Eve Kozak bar Venue Hire: $900.00 (includes the use of Kozak
Room, kitchen & Foyer area only plus a Care Taker Guard for the duration of the function).
KOZAK BAR ROOM & SERVICED BAR HIRE
*Additional hours available @ $55 p.h.
*BYO NOT PERMITTED*
 Kozak Clubroom & Serviced Bar Package (5 hour): $800.00 – 30 to 50
Guests (Includes one bar person, use of the Clubroom, kitchen & Foyer plus a Care Taker for the
duration of the function)
□ Kozak Serviced Bar Package (5 hours): $950.00 – 51 plus Guests
(Includes two bar persons, Clubroom, kitchen & Foyer area plus a Care Taker for the duration
of the function).
 New Years Eve Kozak Serviced Bar Package (6 hours): $950.00
– 30 to 50 Guests (Includes one bar person, Kozak Clubroom, kitchen & Foyer plus, a Care
Taker for the duration of the function).
3
K
O
Z
A
K
B
A
R
 New Years Eve Kozak Serviced Bar Package (6 hours): $1,100.00 - 51
plus Guests (Includes 1 Bar Person, Kozak Clubroom, Kitchen & Foyer plus, a Security
Guard for the duration of the function).
 Bump In/Out: $50.00 p.h. (minimum 3 hours, depending on availability)
Bond: $500.00 (Refundable, Conditions apply refer to the Terms & Conditions attached)
Accessories (place a tick next to the applicable hire)
 Cordless Microphone Hire: $50.00 per day
 Sound Equipment Hire: $70.00 per day
Client Cost
Clubroom Hire:
$_________.00
Bar & Clubroom Hire: $_________.00
$500.00
Bond:
Sound Hire:
Office Use Only
Value of Bond Refunded: $_________
Cheque No:_____________________
$_________.00
Date Completed:_________________
Bump In/Out:
$_________.00
Total Cost:
$_________.00
Receipt No:_____________________
Payment Details
Bond
Date Received: _____/_____/_____ Type of Payment: ________________
(Cash, Cheque, Direct Debit (EFT)
Receipt No: _________________________
Bond Cheque Refunded to Name:
______________________________________________________
Address:________________________________________________
___________________________________________P/C_________
4
K
O
Z
A
K
B
A
R
Venue Hire Balance
Balance $ Value: $__________ Date Balance Due: _____/_____/______
Type of Payment: ___________________ (Cash, Cheque, Direct Debit, EFT)
Receipt No: ____________ Date Payment Received: _____/_____/_____
PAYMENT MAY BE MADE BY:
Cash, Cheque or Direct Debit (EFT)
(All Cheques are made payable to: Kozak Bar – Social Club, Please allow 10 working days for
cheques to be cleared.)
Direct Debit (EFT) Payment shall be paid to:
Account Name: Kozak Bar/Social Club
BSB: 704 - 235
Account No: 0280 2008
Please notify us of all Direct Debit / EFT payments via email to:
enquiries@theballroom.net.au, marked to the attention of: Centre Manager
FULL AND FINAL CONFIRMATION IS ONLY GIVEN UPON RECEIPT OF
PAYMENT OF THE AGREED AMOUNT OF BOND PLUS A COMPLETED AND
SIGNED COPY OF THE KOZAK BAR VENUE HIRE BOOKING FORM
BALANCE OF VENUE HIRE WILL BE INVOICED 4 WEEKS PRIOR TO THE
EVENT, RETURN OF BOND (subject to terms & conditions) IS POSTED TO
THE CLIENT WITHIN 4 WEEKS AFTER THE CONCLUSION OF THE EVENT.
5
K
O
Z
A
K
VENUE HIRE TERMS & CONDITIONS
Activities Permitted

Family or Private function (weddings, engagement, christenings and
birthday parties)

Social, Recreation and Service Club meetings

Art Cultural and craft displays and events

Community group meetings

Musical events of a non-intrusive manner

Registered Political Meetings
Activities Not Permitted

Political Party rallies

Activities likely to cause damage to the premises

Activities likely to cause nuisance to neighbouring residents or commercial
properties
Payment of Hire Charges
All prices are subject to variation and hire fees will be those current at the time the
function is held.
A bond will be required from the hirer of the venue prior to each function and may be
B
A
R
varied depending on the type of function held by the hirer. This will be refunded within
14 working days if not required to cover excess cleaning or repair costs.
A bond must be lodged in conjunction with the Venue Booking Application form to
confirm a booking. If the deposit is not received within 10 business days of the
initial booking being made, the reservation may be cancelled without further
notice. The balance money must be paid at least 14 working days prior to the date
of reservation. If your booking is made within 14 days of the required date,
payment is required immediately.
Sub-Letting
Sub-letting of the halls or any part thereof is prohibited.
Cancellations
Cancellation of bookings must be given in writing not less than 4 (four) weeks prior to
the function date, a deposit will only be refunded less 50% administration cost when
there is another confirmed booking for the function room at the same time and on that
date. Cancellations within 14 days of the hire incur 100% of the total cost of the hire.
6
K
O
Z
A
K
The Kozak Bar /Association of the Ukrainians in SA Inc. reserves the right to refuse an
application for a booking or cancel a booking if it is deemed that the activity being
undertaken does not adhere to the permitted activities.
Accessing Premises
The hirer cannot access the premises earlier than 10.00am on the day of the function
to set up the hall. This allows time for inspection of the venue to occur and any
emergency cleaning from the previous night.
Vacating Premises
The function must conclude by the time specified on the Venue Hire Booking Form and
no later than Midnight in the case of an evening booking. One hour is allowed after this
time for cleaning. Therefore the venue must be cleaned and vacated by no later
than 1.00am in the case of an evening booking.
Within one hour of the termination of the period of hire, or within such other time as
may be approved by the Centre Manager, the hirer shall remove from the building all
materials that are the property of the hirer. Materials not removed within the
stipulated period may be disposed of at the discretion of The Kozak Bar Clubroom
/ Association of the Ukrainians in S.A. Inc.
Damages
Hirers will be required to pay for any property and equipment that is damaged, lost or
B
A
R
stolen as a result of your hire and agrees to indemnify The Kozak Bar Clubroom /
Association of the Ukrainians in S.A. Inc. against all proper costs, charges and
expenses in respect thereof.
Below is an example costs deductible from your Bond prior to refund, if damages
exceed the bond value you will be liable for any extra costs incurred:
Item
Penalty
Damage to the structure of the building
Cost of repair
Electrical equipment
Fee for report or replacement
Damage to tables, chairs, doors, locks or equipment
Cost of repair and replacement
Extra Cleaning (additional cleaning that may include
Cost of additional cleaning services
but is not limited to leftover rubbish or mess, stained
carpets, broken glass, stove/oven/bar area/fridge not
cleaned, counters not wiped.
7
K
O
Z
A
K
B
A
R
Advertising
No advertising is permitted on or in any part of the building and its surrounds without
prior approval from the Manager of the Ballroom Function Centre / Kozak Bar
Clubroom.
Liquor Permit
In accordance with the provisions of the Licensing Act 1997, a Limited Licence must be
obtained for the supply of liquor at a function where either:
 The cost of liquor is to be recouped by imposing an admission/cover charge
on those attending the function or
 Liquor is to be sold or consumed on the premises.
It is the responsibility of the hirer to arrange for the relevant Limited Licence, a copy
which must be lodged with the Liquor and Gambling Commissioner, 9th Floor, East
Wing Zurich Building, 50 Grenfell Street, Adelaide. The hirer must take the licence to
the function.
Please note; that you will need approval from the Kozak Bar Clubroom / Association
of the Ukrainians in S.A. Inc. to support your application when submitted.
Cleaning and Caretaker
A cleaning charge is included in the charge for the venue hire which covers basic floor
and toilet cleaning only plus a caretaker for the duration of the function. The centre
reserves the right to exclude or eject and all objectionable persons from the centre’s
premises without liability.
Prior to vacating the building, it is the Hirer’s responsibility to ensure:
 Rubbish is removed from the internal bins and is to be emptied into
external wheelie bins. External wheelie bins are not to be left inside the
venue.
 All tables, chairs, kitchen, bench and bar areas to be left clean.
 All tables and chairs to be replaced to original locations in the clubroom.
Extra Cleaning fees will apply if the following is present: leftover rubbish or mess,
stained carpets and hard floors, broken glass/dangerous goods, stove/oven/bar
area/fridge not clean, counters not wiped and tables & chairs that require additional
cleaning.
*Cleaning materials and equipment are not provided.
Decorations
The hirer may not affix decorations to the walls, doors and ceiling or any other surface
using adhesive tape, nails, screws, staples or the like that may damage the surfaces.
Decorations must be removed before vacating the premises.
What you need to provide
Hirers are advised that it is their responsibility to arrange for the supply of crockery,
cutlery, glasses, tea towels, napery and all consumable materials including the dish
detergent. Hirers must also provide their own cleaning materials and equipment.
Hirers are advised that it is their responsibility to arrange for the supply of power
boards and extension cords, should these be required.
8
K
O
Z
A
K
B
A
R
What you need to provide
Hirers are advised that it is their responsibility to arrange for the supply of crockery,
cutlery, glasses, tea towels, napery and all consumable materials including the dish
detergent. Hirers must also provide their own cleaning materials and equipment.
Hirers are advised that it is their responsibility to arrange for the supply of power
boards and extension cords, should these be required.
Noise
The volume of music must be controlled in the interests of the nearby residents and
must cease no later than Midnight in the case of an evening booking. The volume of
music played shall be no greater than that which would conform to the provisions of
the Environmental Protection Act. Excessive noise will result in the loss of bond
money.
Fire Extinguishers and Exits
Fire extinguishers are provided for use in emergency situation only and are regularly
tested and tagged. If any fire extinguisher has been released or tags broken or
removed, the hirer will be charged for the cost of refilling, retesting and tagging the
units.
Fire exits are to be used for emergencies only and not for a thoroughfare. The misuse
may result in a security fee callout which will be charged to the hirer.
Smoking
Smoking is not permitted in the Ballroom Function Centre / Kozak Bar building. This is in
accordance with the Ballroom / Kozak Bar Occupational Health and Safety Policy.
Cigarette butts must not be left on the floor or on surrounding footpaths of the building. Failure
to clean up may result in additional fees being charged.
Insurance
Whilst every possible care is taken, no liability is accepted whatsoever or howsoever with
respect to loss, damage, injury or any other cause to any person or property and the hirer shall
indemnify the Association of Ukrainians in SA Inc. from any claim made by any guest, invitee,
licensee or contractor of the hirer.
I acknowledge having read and understood the Conditions and Terms of Hire, for the property
and associated facilities indicated above, and agree to abide by the conditions. I hereby certify
that I am 18 years of age or older.
Print Name:____________________________________________
Signature:______________________________________________
Date:____________________________
9