Intention to Hold an Event Form

This form must be completed if you are planning on organising an event in the Hindmarsh Shire Council Municipality.

YOU ARE REQUIRED TO LODGE YOUR REQUEST A MINIMUM OF 12 WEEKS BEFORE YOUR EVENT.

Large or major events requiring a planning permit may require a minimum of 6 months notification period.

PRIVACY STATEMENT

We will handle any personal information you have provided in this form in accordance with the Privacy and Data Protection Act 2014. Our privacy policy contains information about how you may access your personal information and seek correction of such information; as well as how to complain about a breach of the Australian Privacy Principles and how we will deal with such a complaint. For more information, please see our Privacy Policy or contact our team on (03) 5391 4444. Your personal information will not be disclosed to any other party unless Council is required to do so by law, has gained your consent to do so or an information privacy principle exemption applies.

Name of Event*

Name of Organisation*

ABN (if applicable)

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Email

example@example.com

Website

Location(s) of Event*

StreetRoadReserve

Do you have a confirmed venue/space booking for your event*

YesNo

Name(s)*

Locality*

Frequency*

MonthlyQuarterlyAnnuallySingle Event

Date Reservation

Event Start Time*

:HourMinutesAM/PM Option

Event End Time*

:HourMinutesAM/PM Option

Expected Audience Numbers*

Expected Event Participant Numbers*

Is Entry to the Event Free or Ticketed*

FreeTicketed

Brief Description and type of Event - describe the event and its main purpose*

Emergency Contacts

Will the event possibly require the service of the following emergency services?

If yes, you must contact each individual organisation listed below and advise them of your event

*

	Yes	No
Police
Ambulance
Hospital
Fire Brigade (CFA)

Contact details

Police 03 53911022

Ambulance 03 53912025 or email events@ambulance.vic.gov.au

Hospital 03 53914222

CFA (Fire Brigade) 03 53912071

If you answer yes to any of the below questions, you may be contacted for further information.

Do you require any of the following promotional support? If so there may be a cost associated.*

	Yes	No
Would you like assistance from Council to promote your event?

Do you require any of the following? If so there may be a cost associated.*

	Yes	No
Access to power
Access to water (potable drinking water)
Access to water (non potable)
Access through locked gates/bollards
Access to public toilets
Provision of Council waste receptacles (garbage bins)
Traffic signage
Road closure signage
Reserved parking bays
Temporary footpath or street signs
Site prepared cleaned/clean mowed
Will the event require security fencing/barriers
Installation of street banners/flags

Please note if declared highways are involved separate permission is required from VicRoads Horsham contactable on 03 53819400

Will your event have*

	Yes	No
Live or amplified music
Rides or fair ground attractions
Other entertainment such as a jumping castle
Fireworks
Animals
Will food be sold at the event
Are there any road closures or changes to traffic conditions likely the event
Will there be camping provided on site
Any single marquees, tents or prefabricated buildings greater than 100m2
Any temporary stages or platforms, greater than 150m2
Any temporary seatings stands for more than 20 people
Does the event place have an area less than 500m2 (20m X 25m)
Is the event catering for 5000 or more persons at any one time
Will there be any structural building works or installations of signage
Will the event install portable toilets
Will alcohol be served or sold or brought to the event
Will the event be held on private land
Will a component of the event be held on a lake or river

Intention to Hold Event Form