Application for Temporary Food Stall Permit

Application for Temporary Food Stall Permit
Please note:
- Applications must be submitted at least 7 working days prior to the event
- Late or incomplete applications may not be processed

1.0 - Applicant Details
Name*

First NameLast Name
Email *
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact number*

3.0 - Event Details
Event name (Please note: each event requires a separate application)*
Event coordinator name*

First NameLast Name
Contact number*
Email*
example@example.com
Event location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event start date *

DayMonthYear
Event end date *

DayMonthYear
Event start time*

Hour Minutes

AM/PM Option
Event end time*

Hour Minutes

AM/PM Option

5.0 - Fees
Trading in Public Places - Daily fee of $28.50.

Please note that fees are not applicable for non-profit community organisations and registered charities. Refund of fees will be at the discretion of the Health Services Manager.
Number of days required for permit*
Please attach your Public Liability Insurance Certificate (a minimum of $20 million public liability is required for all food businesses) *

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Please attach your food safety training certificate/s. *

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The Shire offers free online food safety training here.

6.0 - Declaration

I have provided/I acknowledge all of the above information.
Your signature*

First NameLast Name
Date*

DayMonthYear
To make above payment, please contact Health Services on (08) 9729 0328.
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