Private Venue Event Application Form

Event Organiser Details

Full Name *

Organisation Name (if applicable)

Venue Name (if applicable)

Postal Address:

Phone Number: *

Email Address: *

Is this the contact person during the event?

YesNo

Event Details

How many people are expected to be in attendance? *

Event Location (physical address) *

Description of the event *

Example: Tuesday, 12 December 2020 - Start 10:00am to Finish 4.00pm

Enter the Day, Date and Times of your event(s) (for multiple event days, use a new line) *

Is there a cost to attend

YesNo

Will there be be alcohol at this event *

BYOSuppliedSoldNo

Structures and Facilities

Submit Attachments

Risk Management Plan

Current Certificate of Currency (Public Liability)

SITE MAP: Clearly mark event site, emergency evacuation/muster point, toilets and car parking

Declaration

I, (enter your name) *

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

AgreeDo not Agree

Dated: *

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.