Please complete this event application form ensuring you fill out all sections. We recommend that you have a copy of our site plan at hand before making the application. All questions are required unless indicated. You will receive confirmation of the right to hold your event, as described in this application, within two weeks of receipt of this application. Please note, that depending on the complexity of your event it may take up to six weeks to process.

Name of your event:

Dates, Times, Venues

Set up date and time
Event start date and time
Event finish date and time
Site cleared and vacated by date and time
Anticipated numbers of attendees

Brief description of event
e.g. Event type; why you’re holding the event; types of activities involved

Event location



Please attach a map showing which Council reserve you intend to use and specifically what part of the reserve will be occupied by your event. Hand drawn is fine. (File formats accepted: jpg, pdf, docx, max 5Mb)

Contact Details

Group/organisation

Contact person

Postal address

Physical address

Contact Details:
(Please provide at least one phone number and at least one email)

Business Phone: Home Phone:
Mobile Phone: Fax:
Email:

Second Contact Person:

Second Contact Details:
(Please provide at least one phone number and at least one email if there is a second contact)

Business Phone: Home Phone:
Mobile Phone: Fax:
Email:

Parking/Vehicles

Anticipated number of parked vehicles:

Where will people attending the event park their vehicles?

Smokefree Policy

Selwyn District Council has a Smokefree Public Outdoors Policy. This is specific to parks, playgrounds, sports grounds and at Council supported events.

Are you able to support the Smokefree message at your event (e.g. signage - if provided with, PA announcements)?

Regulatory

Health & Safety

Health & Safety Officer

Name
Contact phone number
Email address

Please read and agree to the health and safety requirements below. Selwyn District Council will ensure the venue/location for your event is safe and suitable for the proposed activities and will explain the hazards, risks and the management of these to you prior to operating at this venue/location.

If you have any other documentation to support your application, please attach here.

Privacy Act 1993 - The information collected will be used to ensure the effective processing of your application. It may, therefore, be distributed to other Selwyn District Council departments, external agencies and for public notification as required.

Signed

I the undersigned confirm that the above information is true and factual. I confirm that I am the authorised person for this matter. I accept there may be a bond requirement associated with this application and booking. I  confirm I have read and understood the conditions and requirements that could apply.

Your name: