Large Event Application Form – under 500 people Please ensure before completing this application that you have read and understood the Box Moor Trust Conditions for Hire of Land for the Purpose of a Public Event or Function. Completing this application form does not guarantee your hire and is not considered confirmation of hire.Contact DetailsName of company or promoting organisation(Required)Company/organistion number(Required)Contact name(Required) First Last Company/organisation address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact phone number (daytime)(Required)Contact mobile phone number(Required)Contact email address(Required) Contact name(Required) First Last Will the above named person be the onsite contact during the event?(Required) Yes No Site contact phone number (daytime)(Required)Site contact mobile phone number(Required)Site contact email address(Required) Event DetailsType of event(Required)CircusFunfairA fairotherIf other please specify(Required)Please note, if your application is to apply for a small event please use our Small Event Application FormDescription of eventSite required for event?(Required)Blackbirds MoorOtherIf other please specify(Required)Dates and TimesProposed dates are inclusive of setup and take down.Proposed date of arrival(Required) Day Month Year Proposed time of arrival(Required) Hours : Minutes AM PM AM/PM Number of set up days(Required)i.e. days to set up the siteNumber of operating days(Required)i.e. days where the event is open for businessNumber of take down days(Required)i.e. packing up and site clearanceTotal number of days on siteProposed date of departure(Required) Day Month Year Proposed time of departure(Required) Hours : Minutes AM PM AM/PM Attractions and CapacityNumber of staff on site(Required)Seating capacity of big top(Required)Please specify the name of each powered ride you intend to have onsite, and if you hold a relevant ADIPS form for each.(Required)Name of powered rideDo you hold a relevant ADIPS form for this ride: Y/N Add RemovePlease note: copies of all relevant ADIPS forms must be forwarded upon request.Intended number of stalls on site?(Required)If none, please record 0.Toilet facilities(Required)Depending on the size of the event, you will need to ensure there are adequate toilet facilities for your attendees. I will ensure there are adequate toilet facilities provided for the public to use during the event.Will you be using any third parties to supply good or services at your event?(Required) Yes No Please could you provide details of the third party and what services/goods they will be supplying.(Required)Company/organisationService/goods Add RemoveVehicles On SitePlease list all of the vehicles you plan to have on site during your event.(Required)This should include all vehicle types used for transporting equipment and their weight, and all temporary accommodation vehicles.Vehicle typeWeightNumber of vehicles Add RemoveDo you plan to have carparking for attendees on site?(Required)Please note: you will be entirely responsible for marshalling carparking and ensuring safety of all using the site. All areas of the Box Moor Trust Estate are open access to members of the public.YesNoDocument UploadsIn order to consider your application we require a provisional site plan and provisional risk assessments. We understand these may not be complete. We make make recommendations and should we agree your application we will need final, full and complete documents 14 days before any occupation of the land.Please upload a copy of your provisional site plan.(Required)Please use the downloadable map from the website, or request a map of the area reqired.Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 128 MB.Please upload a copy of of your public liability insurance certificate.(Required)Please note you will need to have a policy of insurance against third party risks/public liability to a minimum value of £10,000,000 for any one claim.Max. file size: 128 MB.Please upload a copy of your provisional event risk assessment.(Required)Max. file size: 128 MB.Please upload a copy of your provisional event fire risk assessment, if separate.Max. file size: 128 MB.Please upload a copy of your provisional event safety plan.(Required)Max. file size: 128 MB.DeclarationsPlease ensure that you have thoroughly read and understood the Conditions of Hire document, found on our website.Declaration of authority(Required) I have the authority to apply on behalf of the company/organisation to make this applicationAgreement of charges(Required) I agree to pay all charges properly applicable to the hire of the land as specified by the Box Moor Trust. I understand I/the company or organisation will be liable for any repair or reinstatement of the land and/or the Estate caused as a direct or indirect result of our hire.Land bond(Required) I understand the Box Moor Trust is entitled to make deductions from my land bond to cover any water/waste charges, and any repair or reinstatement charges.Declaration of understanding(Required) I have read, understood and and agree that I, and all persons acting on behalf of the company/organisation will abide by the Box Moor Trust’s Conditions of Hire of Land for the Purpose of a Public Event or Function. 85851
