Street Musician's Licence Application

Street Musician's Licence Application
1. General Information
Name*

First NameLast Name
Date of birth*

DayMonthYear
Date
Residential address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Postal Address (if different to residential address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

2. Contact Details
Phone number

Area CodePhone Number
Mobile phone number*

Country CodeArea CodePhone Number
Email address*
example@example.com

3. Location and Type of Entertainment
Location
Type of musical entertainment to be provided
Number of persons

4. Terms and Conditions
AGREEMENT SIGNED BY APPLICANT

Hereby makes application for a Street Musician’s Licence, in terms of city bylaws applicable thereto.
Accompanying this application is payment of the requisite fee of $20.00 applicable only to persons of 18 years and over.
The licence fee may be waived in the case of charitable organisations or for an approved fund raiser.

I certify that:
1. I will comply with the terms and conditions of the licence
2. Where this application relates to a group of persons or an organisation, I am the person authorised to apply
on their behalf
3. I acknowledge that any breach of the licence conditions will result in cancellation of this licence

CONDITIONS OF APPROVAL

· The applicant or nominated representative in the case of a group or organisation is responsible for compliance
with the licence conditions
· The licence may be revoked or suspended at any time if the applicant fails to meet the conditions of approval
· The licence is not transferable
· The licence shall be produced for inspection by Police or an authorised Council officer
· The licence holder shall comply with any direction issued by Police or authorised officer of Council. This
includes the immediate cessation of any musical performance or event notwithstanding the fact that a licence
may be currently in force
· The use of amplified or public address equipment is prohibited
· A street musician shall not remain continuously in any one location for any period longer than two hours
unless authorised by the licence
· Pedestrian and road traffic must not be obstructed or otherwise impeded
· The musical entertainment must not be of an offensive nature or give rise to nuisance to adjacent commercial
business operations or residents

PRIVACY STATEMENT
The council may hold, use and disclose personal information you have provided
· to communicate with you for council purposes;
· to tell you about products and services it believes may be of interest to you; and
· to enable it to maintain its records and carry out its statutory functions.
You have the right under the Privacy Act 1993 to access, and have corrected, information held by the
council, which is at 30 Laings Road, Lower Hutt 5040, telephone 04 570 6666.
Signature of Applicant or Parent/Guardian (if applicant is under 18 years of age)

Clear
Date

MonthDayYear
Should be Empty:

Street Musician's Licence Application

1. General Information

2. Contact Details

3. Location and Type of Entertainment

4. Terms and Conditions