由办事处填写For Official Use.doc

由辦事處填寫For Official Use 編號 No. 收表日期 Date 組別 Cat. (1) 申請人姓名 Name of Applicant: (2) 香港身分證號碼(首四個數字) (3) 職位 Hong Kong Identity (ID) Card No. (First 4 digits): Position Held: (4) 所代表機構／團體的名稱 Name of Organisation Represented: (5) 機構／團體的郵遞地址 Postal Address of Organisation: (6) 電話號碼 () 傳真號碼 Tel. No.: Fax No.: () 機構／團體的相關註冊證書 No. of Relevant Registration Certificate of the Organisation: (9) 擬租用的設施 (10) 用途 Purpose of se: (11) 租用日期(請列明) of Use (Please specify): (12) 租用時間(請列明) Time of se (Please specify): (13) 預期參人數 ed Number of Participants: (14) 會否向參加者收取費用 會不會 Will you collect fees/charges from the participants? * Yes/ No 如會收費多少 每位 If yes, how much? $ per person (15) 活動會否帶來其他收入 會不會 Will any other income be derived from the activity? * Yes/ No 如會收入多少 (ii) 來源(請明) If yes, (i) how much$ (ii) source (please specify) : (16) 活動的負責人(請提供兩名負責人，其中一名負責人須預訂的段場地) Name of responsible persons of the event (Please provide the names of two responsible persons, one of whom must be present at the booked session to take up the booking at the venue.): 負責人(A) Responsible person (A) 先生女士* Mr/Miss/Ms/Mrs 職位 Position Held: 身分證號碼(首四個) Hong Kong ID Card No. (First 4 digits): 電話號碼 Tel No.: 負責人(B) Responsible person (B) 先生女士 * Mr/Miss/Ms/Mrs 職位 Position Held: 身分證號碼(首四個) Hong Kong ID Card No. (First 4 digits): 電話號碼 Tel No.: 本人已閱並承諾遵守康樂及文化事務署康體設施用條件.hk/tc/condition/index.html)。租用期間，疏忽而任何人損失損傷亡，以致人署提出任何訴訟、申索或求，須向署作出彌償。 I have read the Conditions of Use of Leisure and Cultural Services Department (LCSD) Recreation and Sports Facilities (website: .hk/en/condition/index.html) and I undertake to observe the Conditions. During the hire period, I shall indemnify the LCSD against all actions, claims and demands by any person who suffers or sustains any loss, damages, injury or death arising out of or as a result of the use of the facility/facilities by me or a person authorised by me due to my negligence or the negligen