Public Space Reservation

Public Space Reservation
Name

First Name Last Name
Organisation
Postal Address

Street Address

Street Address Line 2

Suburb State

Post Code
Email *
example@example.com
Mobile Number *
Please enter a valid phone number.

Is this an education display

Yes No Other

Event Location
Date of Event

Day Month Year
Start Time *

Hour Minutes

AM/PM Option
Finish Time *

Hour Minutes

AM/PM Option
Please give a description of the information that will be distributed to the public *
Will there be any temporary structures used at the event

No Exhibition Stands, Tables Marquees Temporary Seating / Spectator Grandstands Stages or Stage Sets and Scenery (Large Props)
Will you require power

No Yes (use of existing fixed outlets) Portable Generator Both Fixed and Portable Generator

Submit Attachments
Current Certificate of Currency (Public Liability)

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Cancel of
Emergency or Risk Management Plan

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Cancel of
Site map of the area you wish to use. Clearly mark event site, emergency evacuation/muster point, toilets and car parking

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This can be a snapshot of google maps with the areas marked on it.
Cancel of

Declaration

I declare that the information I have provided in this application form is true and correct, I am aware that it is an offence to provide false and misleading information.

Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature. The electronic signature will be equally as binding as an original manual paper signature.
Signature

Clear
COVID-19 Disclaimer: The Shire of Denmark will continue to assess events in accordance with the requirements of the Health (Public Buildings) Regulations 1992, however event organisers must understand that approval by local government does not guarantee that the event will proceed. Local governments can process event applications, granting conditional approval in anticipation of the relevant restrictions being lifted by the time the event is due to take place.
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Public Space Reservation

Event Details

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