Application for Use of Public Swimming Pool

Application for Use of Public Swimming Pool
This application is for booking seasonal programs at the Yass and Binalong pools. Applications close on the 31st of July each year. Applications are assessed and applicants advised by the end of August.

Applicant Details
Name *

First Name Last Name
Email *
example@example.com
Phone Number

Area Code Phone Number
Mobile Number *
Are you a registered not for profit organisation? *
Not-for-profit status will be determined for organisations that are an incorporated association. Please attach a copy of your constitution identifying the organisation as not-for-profit.
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Address

Street Address

Street Address Line 2

City State

Postcode Country

Proposed Swimming Program
Name of Representative

First Name Last Name
Pool Required
Special requirements
Number of lanes required
Lane allocation is subject to change at the direction of pool staff
Expected number of users
Accessibility
Describe how people on low income, people with a disability, people of varying skill levels will be able to participate.
Range of service (What classes do you offer?)
What community benefit does your service provide?
Demonstrate the overall benefit of your service to the community.
Range of age and targeted swimming ability of group.
Number of swimmers under 10 years of age
Number of coaching/teaching staff required
(Certification of all teachers/coaches will need to be provided to YVC)
Period of Use

Day Month Year
Start Date
Day Month Year
End Date
Days Required

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Note: Hire is only available during advertised pool opening times. See the website for further information.
Monday Start Time
Monday end Time
Tuesday Start Time
Tuesday end Time
Wednesday Start Time
Wednesday end Time
Thursday Start Time
Thursday end Time
Friday Start Time
Friday end Time
Saturday Start Time
Saturday end Time
Sunday Start Time
Sunday end Time
Note: All users must complete a risk assessment each and every time the pool is used/hired and retain a copy for your records.
Additional Information

Attach Documents

Please upload at least the following documents and any other relevant information to support your application.

Failure to provide the required documentation will result in your application being refused.

1.	Certificate of Currency – Public Liability Insurance with a minimum of twenty (20) million dollars
2.	Instructor/AUSTSWIM Certification, Coach – Certification and First Aid (for all teaching staff)
3.	Swimming Pool User Agreement - Read, completed and signed

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Conditions Of Use

1.	All applicants must provide a signed Pool User Agreement before their application is assessed.
2.	Council facilities must be left in the same condition in which they are found.
3.	The user is responsible for cleaning of all rubbish before departing from the centre and returning all equipment to its appropriate place.
4.	The user must ensure that all fixtures and fittings are not removed, defaced, or damaged in any manner by persons using the facility. If in the event of damage the cost of repair will be the responsibility of the hirer.
5.	No permanent decorations, fixtures, or posters of any manner are to be erected in any part of the pool and surrounds without the written permission of Yass Valley Council.
6.	All breakages, damages, or losses must be reported immediately to the Pool Lifeguards and an incident report completed.
7.	For the purpose of the issue of Family Passes, a “Family” is defined as “the names listed on a Medicare Card”.
8.	It is the responsibility of the hirer to ensure that all activities conducted within their responsibility abide by these Conditions of Use. As such, the following activities are not allowed: Drinking of any alcoholic substance Use of any Drug related substance Smoking Swearing or abusive behaviour Dangerous or unsafe behaviour Destructive behaviour to property and fixtures of the Swimming Pool No glass containers of any kind to be brought into the pool grounds. No pass-outs will be issued for any of Council’s Aquatic Facilities.
9.	Pool staff have the discretion to allocate lane space subject to the number of swimmers on the day(s) of the users approved booking.
10.	No advertising material is to be displayed on Council premises (Including the pool sites)
11.	All hirers shall comply with Yass Valley Council Conditions of Use of premises and equipment as set out above. Any failure to abide by these conditions shall result in cancellation of this agreement.
12.	Please refer to Council’s current Fees and Charges for the applicable lane hire fees
13.	No refunds for non-use of scheduled bookings unless Council closes the pool for other uses
14.	Council reserves the right to reduce the number of available lanes or postpone/reduce hire if required

Privacy and Personal Information Protection Notice

Purpose of Collection:	For assessment of this application for use of public swimming pool.
Intended recipients:	Council staff and approved contractors of Council.
Supply:	Voluntary. If you do not provide all details requested, Council may be unable to, or limited in its future correspondence with you.
Access / Correction:	Contact Council Customer Service Team on (02)6226 1477 to access or correct this information.
Storage:	Yass Valley Council, 209 Comur Street Yass, NSW 2582

Privacy and Personal Information Protection Act 1998

Compliance with Section 10

This information is required to ensure that Council can communicate with you in relation to this application for use of a public swimming pool. The information is private and confidential and Council must not disclose the information to any person or body if it is not directly related to the purpose for which the information was collected.

If you have a complaint about the use of your personal information, contact the Yass Valley Council Public Officer. The information contained or referred to in this form may be corrected and updated by you, by contacting the Council.

Privacy Statement

You will need to provide personal information to Yass Valley Council in respect of this application. Council is required under the Privacy & Personal Information Protection Act 1998 (PPIPA) to collect, maintain & use your personal Information in accordance with the Privacy Principles & other relevant Requirements of the PPIPA. For further clarification please contact the Privacy Contact Officer at Yass Valley Council

Declaration *

I acknowledge that by submitting this form I have read and agree to the conditions of use listed above.
*
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