Application for hire of local government property

Application for hire of local government property

If assistance is required in completing this form, please phone 9729 0300.
1.0 Contact details
Name of Organisation*
Please provide details of two representatives from your organisation
Person 1 Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Person 2 Name*

First NameLast Name
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

3.0 Event Details
Purpose of venue hire*
Single or regular use*

Single useRegular use
Start date*

MonthDayYear
End date*

MonthDayYear
Start time*

Hour Minutes

AM/PM Option
End time*

Hour Minutes

AM/PM Option
Estimated number of people attending*
Please provide a list of dates and times.*

4.0 Alcohol
Is alcohol to be consumed on the premises?*

YesNo
If yes, please obtain a Permit to consume alcohol on shire property at least 14 days prior to the function.
Is alcohol to be sold on the premises?*

YesNo
If yes, please obtain an Occasional Liquor Licence from the Office of Racing, Gaming and Liquor. Click here for further information about how to apply.
Permit Number*
Date of issue*

MonthDayYear
Period Issued for*

5.0 Application Declaration
Please Note

Bookings are to be lodged with the Shire three weeks prior to the booking date. Bookings will be confirmed when all payments have been received by the Shire. The Shire reserves the right to refuse any booking for any reason.

Cancellations

If an applicant cancels more than one month before the function, then they are entitled to a full refund of all charges and bonds that apply to that booking.

If the applicant cancels less than one month before the function, then they may apply to the Shire to change or alter the activity to another date. The Shire may approve or refuse a change at its discretion. If the applicant cancels less than one week before the booking date, a cancellation fee of 50% of the hire fee will apply.

Public Liability Insurance

The Shire of Harvey Insurers do not provide Public Liability coverage for any person or group of persons that are an Association, Corporation, Sporting Body, Club, Business or Incorporate Body who hire a Shire facility.

Hirers are required to take out Public Liability Insurance with a minimum cover of $20 million to protect their group from any damage or injury that may occur. When required, evidence of Public Liability cover must be provided prior to commencement of hire.
Acknowledgement*

I agree to comply with all provisions of the Shire of Harvey Local Government Property Local Law andother written laws pertaining to the proposed use, including any condition which may be imposed onthe permit of hire requiring me to indemnify the local government in respect of any injury to any personor any damage to any property which may occur in connection with the hire of local governmentproperty.
Signature*

First NameLast Name
Date*

MonthDayYear
Email*
example@example.com
Should be Empty:

Application for hire of local government property

1.0 Contact details

2.0 Venue Details

3.0 Event Details

4.0 Alcohol

5.0 Application Declaration