Application to Conduct Activities in the Mount Barker District Fundraising-Busking-Filming-Private Events (PLEASE ALLOW 10 WORKING DAYS FOR PROCESSING) Pursuant to By-Law 4 Part 3 Section 9 - Council land Name of Applicant* First Last OrganisationAddress* Address Line 1 Address Line 2 Suburb State Post Code Preferred Contact Phone Number*Preferred Phone Number and contact time Contact EmailA pdf confirmation of your submission will be sent to this email address if entered. Enter Email Confirm Email Activity (please select)* Fundraising Busking Private Event Distributing Flyers Sampling Photographic Shoot Filming / TV / Video Display Other NB - Fundraising is limited to a maximum of 3 (three) people at any one time and 2 (two) bookings in total per week. Other (Please specify)*Detailed Description of Activity and Infrastructure being supplied*Are you a Registered Charity, Professional Musician or BusinessNoYesPublic Liability Insurance*A copy of your current Public Liability Insurance with a limit of Indemnity not less than $10,000,000 must accompany each application form. This is mandatory for all Registered Charities, Business and Professional Musicians. Please upload your copy here. Accepted file types: jpg, jpeg, pdf, png, docx.** Please Note any file uploads must be of type jpg, jpeg, pdf, png, docx Site PlanPlease include a Site Plan if necessary Accepted file types: jpg, jpeg, pdf, png, docx.Location* Keith Stephenson Park, (Site Plan required) Other Please provide Address Details of 'Other' Location*Please upload a Site Plan for Keith Stephenson Park*Click here for a map of Keith Stephenson Park Accepted file types: jpg, jpeg, pdf, png, docx.Date/s Required(Click + or - to add or remove a date) Enter the Time Period required*The Permit Holder agrees to indemnify the Council from and against all actions, costs, claims and damages, which may be brought or claimed against the Council arising from the operation of the applicant. The Permit Holder agrees to release the Council from any liability or claim resulting from any accident, damage or injury occurring on or in the street, road, infrastructure or land. The Permit Holder agrees that the Council will have no responsibility or liability for any loss or damage to the Permit Holders fixtures or fittings or personal property. I have read and agree to the Conditions of Application (click here to view) Applicant Signature*Date of Application* CAPTCHAEmailThis field is for validation purposes and should be left unchanged.