Application for use
of a Municipal Reserve
Location of Reserve
Area/s required
Requested date(s) of use
Nature of activity/intended use
Time requested (allow for setting up and cleaning up)
Start
Finish
Do you have an existing insurance policy, with at least ten million dollars cover, that will cover this activity/event?
Yes - a Certificate of Currency must be provided with this Application
No
Organisation
Contact Name
Postal Address
Residential Address
Telephone
Fax
Mobile
Email
Comments
ALCOHOL - Will alcohol be consumed at the event?
Yes
No
FOOD - Will there be food for sale at the event?
Yes
No
Will your event require an Occupancy Permit for a Place of Public Entertainment?
Yes
No
Place of Public Entertainment (POPE) examples include open air event where public are charged admission, free open air events
in areas sectioned off exclusively for the event, marquees >100m2, stages >150m2.
Additional information is available on the Council website.
If applicable, do you require an invoice for the security bond and hire charge?
Yes
No
Will signage be erected at the event?
Yes
No
Will amplification equipment be used? If yes, refer to item 19 in terms & conditions
Yes
No
Will a marquee or other portable structure be erected? (Terms & conditions - 20)
Yes
No
Is removal of bollards required for access to the municipal reserve?
Yes
No
Will vehicles be taken onto the municipal reserve?
Yes
No
Yes
No
If yes, provide details
If yes, provide details (inc. size)
If yes, provide details
Is assembly of the stage required? (Atkinson Park Kerang / Garden Park Cohuna sound shells)
If yes, please advise time for: assembly
and dismantle
Please complete and return pages 1 – 4 and attach insurance Certificate of Currency if required
In person: Kerang or Cohuna Office
Fax: 5450 3023
Email: council@gannawarra.vic.gov.au
Mail: PO Box 287 Kerang Victoria, 3579
Please retain the Terms and Conditions of Use and General Information sections for future reference
Updated 2015 09 30
Page 1 of 10
Application for Use of a Municipal Reserve
FORM OF INDEMNITY
This section to be completed by the applicant or their authorised representative
I
(Name of person)
of
(Address of person)
in the State of Victoria, holding the position of
(Role or position in organisation)
in the organisation named
(Organisation name)
of
(Organisation address)
for which business I am duly authorised to sign this indemnity, in consideration of the Permit for use of
Council land or Municipal reserve, being granted to:
(Name of the person or Organisation name on the permit)
(referred to as “the Permit Holder”) HEREBY COVENANTS with GANNAWARRA SHIRE COUNCIL (hereinafter
referred to as “the Council”) that unless caused by a breach of statutory duty or common law by the
Gannawarra Shire Council or any of its officers, agents, employees or contractors, the Permit Holder agrees
to indemnify the Council and keep the Council indemnified from and against all and any damage, loss, cost or
liability incurred or suffered by any person as a result of the Permit Holder’s failure to comply with any
conditions of the Permit granted by the Council, or any other failure to comply with any relevant law, lawful
duty or obligation giving rise to any damage, loss, cost or liability incurred or suffered by any person as a
result of or in any way associated with the exercise of this Permit.
SIGNED SEALED AND DELIVERED by

(Print Name)
Signature of applicant
(Print Position)
(Date)
in Victoria in the presence of:

(Print Witness Name)
Witness signature)
(Date)
Page 2 of 10
Application for Use of a Municipal Reserve
PRIVACY COLLECTION NOTIFICATION
The information collected on this form is for the purpose of processing your booking for the use of a municipal reserve.
Your information may be disclosed to other organisations for the purpose of administration of the booking. Your
information will not be otherwise disclosed except as required by law. If you fail to provide all information then your
booking may not be processed. You have the right to access and correction of your personal information. All questions,
concerns or complaints regarding Privacy can be made in writing to:
Information Privacy Officer
Gannawarra Shire Council
PO Box 287 KERANG, 3579
I, the undersigned agree to the terms and conditions of the Municipal reserve application. I understand and agree
to the privacy notification outlined above.
Signature
Name
(Signature of applicant)
(Please Print Name)
Council
Rep Initials
Witness
(Signature)
(Print name)
In making this application, it is hereby acknowledged that the document ‘Terms and Conditions of Use’ has been
received and examined by me/us and I/we are aware of and accept that, if this application is approved, the
conditions, indemnities and other authorities and requirements set out in that document become part of the
agreement to use the municipal reserve named on the application.
Signed
Date
(Signature of applicant )
For and on behalf of
(name of organisation)
This form must be signed on behalf of the Gannawarra Shire Council
Signed by Council Representative
Printed Name:
Date
A security bond may be required for this event. Subject to the conditions of use, the bond will be refunded. The
hire charge must be paid at least 7 days prior to the event.
Bond amount (Recreation reserve) - No alcohol: $235 /Alcohol to be consumed: $550
Bond Amount
Date Paid
Receipt #
CS
Signed by Council Representative
Bond to be Reimbursed by:  Cheque  Direct Deposit (if direct deposit please refer to Page 3)
Hire Charge
Date Paid
Receipt #
CS
Signed by Council Representative
If hire charge is not applicable, an application and permit fee will apply for use of a Municipal Reserve.
Refer to Council Fees & Charges - Recreation Reserves or Local Law Permits
Page 3 of 10
Application for Use of a Municipal Reserve
BANK ACCOUNT DETAILS
To have your Security Bond/Refundable Deposit reimbursed directly
into your bank account, please complete the following details:
Name
Address
Bank name
(eg ANZ, Bendigo Bank)
Branch name
BSB number
(This is usually a 6 digit number)
Bank account number
(Up to 9 digits)
Account name
Email address
(to send Remittance advice)
or
Fax number
(if you do not have an email address)
ABN
Signed
Printed name
Date
Please note: If you do not have an email address or fax your remittance advice will be sent via post.
Page 4 of 10
Application for Use of a Municipal Reserve
TERMS AND CONDITIONS OF USE
1. Application
A verbal booking may be made with the Gannawarra Shire Council but written confirmation is required on the ‘Application
for Use of a Municipal Reserve’. The form must be completed and returned to the Gannawarra Shire Council Kerang or
Cohuna Office.
2. Booking process / Inadequate or False Information
Confirmation of casual use bookings should be made on the appropriate Permit application form. The completed form should
be forwarded with payment at least 10 business days prior to the proposed use. The Permit includes a booking confirmation
and will be forwarded to the applicant.
If payment is not received with the Permit application, any booking may be cancelled.
You must declare all relevant facts on your Permit application, in order for Council to assess the application. If you fail to do
so, your Permit may not be issued and any booking may be revoked without notice. Council will not be held liable for any
damages or losses incurred. Permit applications should be received by Council at least 10 business days prior to the booking
date. All bookings are subject to availability, suitability and are completely at Council’s discretion.
3. Payment
(a) The user agrees to pay immediately upon booking, $__________ security bond/refundable deposit as a booking fee;
and/or
(b) The user agrees to pay, at least seven days prior to the event/activity, the sum of $__________ being the estimated hiring
charge in accordance with the current rates of use.
The user is aware that all other charges that may accrue in connection with the booking, such as hiring extensions,
breakage or damage to the facility or equipment, or extra cleaning etc, will be deducted from the security
bond/refundable deposit.
4. Cancellation
The user reserves the right to cancel this booking at any time and acknowledges that in this case, the user will receive a
refund of monies paid on the following basis:
a) If cancelled within 30 days of the date booked, NO REFUND of the booking fee.
b) If cancelled more than 30 days but less than 90 days prior to the event/activity, 50% of the booking fee will be
refunded.
c) If cancelled at least 90 days before the event/activity, the full amount paid will be refunded.
Failure to inform Council of any cancellation of booking(s) prior to the event may result in a charge equivalent to the
relevant facility use charge.
5. Fees
Prices are subject to alteration at any time with 30 days notice. Price variation will not affect confirmed bookings.
6. Liquor and food
Between sunset and sunrise, a person must not, on any Municipal Reserve, whether it be a Road within a Municipal Reserve
or not, or in any motor vehicle within a Municipal Reserve, consume any Liquor, or have in his or her possession or control,
any Liquor, other than Liquor in a container with an unbroken seal.
No alcohol or food can be served as part of a commercial arrangement without the necessary Permit approval from Council.
IT IS THE USER’S RESPONSIBILITY TO ENSURE ALL LICENSING AND LOCAL LAW REQUIREMENTS ARE MET. Further
information is available on the Victorian Commission for Gambling and Liquor Regulation
http://www.vcglr.vic.gov.au/home/liquor/
1300 1 VCGLR (1300 182 457)
7. Damage
The user agrees that any damage sustained to the facility and/or equipment, or removal of equipment, during the use of the
facility will result in:
a)
loss of Security Bond/Refundable Deposit (to the value of the loss)
Page 5 of 10
Application for Use of a Municipal Reserve
b)
appropriate charges to the user.
8. Security Bond/Refundable Deposit – No Alcohol $235, Alcohol $550
If the Hirer causes damage, Council retains the right to withhold part or all of the security deposit towards the cost of repair
and/or reinstatement. If no security deposit is held, Council retains the right to invoice the Hirer the full cost of repair and/or
reinstatement.
9. Safety
For the duration of the hire period the facility will be under the physical and legal control of the user. It is the responsibility of
the user to inspect and approve the hired facility as being safe to use for the intended event/activity. If considered unsafe,
the facility will not be used and Council will be notified of the problem. It the facility is used, it will be deemed to be an
acknowledgement that the facility is fit and proper for the intended use and accepted that all liability associated with the use
of the facility shall rest with the user.
10. Crowd control
The user is responsible for providing adequate crowd control for the event.
11. Occupancy Permit for a Place of Public Entertainment
The user agrees to determine the requirement for an Occupancy Permit for a Place of Public Entertainment, and if required,
agrees to obtain an Occupancy Permit prior to conducting the event. Further information and application forms are available
from the Council website.
12. Vacating facility
All persons attending the event/activity are to vacate the facility within 30 minutes of the agreed vacating time. A nominated
person is to be the last person to leave the facility to ensure this requirement is met. If the facility is not vacated within this
time, an additional charge may be levied.
13. Condition of venue
The Hirer agrees and acknowledges that the venue and/or reserve is in good repair and clean condition at the
commencement of the hire period and must be returned to the Gannawarra Shire Council (Council) in the same condition at
the end of the hire period.
The Hirer shall reimburse Council for the cost of any reinstatement or repairs occasioned as a result of any damage to
property resulting from the conduct of the function and any associated activities.
Due care is to be exercised at all times, with the protection of all natural vegetation and geographical features in the area
being a prime consideration.
14. Litter
Litter generated shall be removed from the site immediately after the event. The user is responsible for removing and
disposing of rubbish. External Ellwaste waste and recycle bins may be used where provided, however in the event that the
bins are filled to capacity, the user is responsible for removing and disposing of the excess waste.
Confetti is considered litter and should not be used. This is an offence under the Environment Protection Act 1970 No. 8056
Section 45E. If the site is left in an unclean condition following usage, the Council retains the right to withhold part or all of
the security deposit towards the cost of any clean-up.
15. Public Liability Insurance
Council reserves the right to make a condition of this Permit that the Applicant show evidence of current public liability
insurance to an amount approved by Council, depending upon the nature of the proposed activity.
For multiple hire dates, and where the current insurance policy will expire during the hire period, hirers must provide Council
with a new Certificate of Currency as evidence of currently maintained public liability insurance cover for the new insurance
period.
16. Indemnity
The Permit Holder hereby covenants with Gannawarra Shire Council (hereinafter referred to as “the Council”) that unless
caused by a breach of statutory duty or common law by the Gannawarra Shire Council or any of its officers, agents,
Page 6 of 10
Application for Use of a Municipal Reserve
employees or contractors, the Permit Holder agrees to indemnify the Council and keep the Council indemnified from and
against all and any damage, loss, cost or liability incurred or suffered by any person as a result of the Permit Holder’s failure
to comply with any conditions of the Permit granted by the Council, or any other failure to comply with any relevant law,
lawful duty or obligation giving rise to any damage, loss, cost or liability incurred or suffered by any person as a result of or in
any way associated with the exercise of this Permit.
17. Signage
The use of any portable, freestanding signs on or above any roadway, footpath or public place without prior approval from
the Responsible Manager is prohibited.
18. Council direction
The Hirer shall have regard to any lawful direction or instruction given by an authorised officer of the Council in relation to
the conduct of the function.
All Council Local Laws must be complied with at all times.
19. Amplification equipment / noise
The use of any amplification equipment shall be kept to a level prescribed by the Environment Protection Act (72 decibels and
must not disturb other users).
20. Marquees and other portable structures
Gannawarra Shire Council may require a Security Deposit of $500 if a portable structure and/or other infrastructure is to be
located on the site.
The Security Deposit will be refunded by cheque within 4 weeks after the function, subject to the site being left in a
satisfactory condition.
No ground penetration securing system or device is permitted at parks with irrigation systems.
If required for this permit, a current Certificate of Currency of the supplier’s Public Liability insurance for a minimum of $10
million must be provided to Gannawarra Shire Council prior to approval being granted.
Please also refer to condition 11 - Occupancy Permit for a Place of Public Entertainment re: marquees >100m2
21. Booking BBQ’s, park structures and amenities
No park amenities, structures or BBQ’s can be booked.
22. Conduct of patrons
Please ensure that all users connected with your booking conduct themselves with due respect and consideration of others
with regard to shrines, memorials, park furniture, structures and amenities.
23. Filming and photography
(a) If filming and photography is for private, non-commercial, community and/or social media purposes and the images will
not be publicly exhibited or broadcast for television, then no permit is required. All other filming or photography that is
conducted for commercial or television broadcasting purposes or for public exhibition, excluding news media must not
be undertaken on land that is managed by Council without a permit.
(b) Where a permit for filming or photography on Council Land is required:
The production company (the permit holder) may be required to letter box drop ALL residents and businesses which
may be affected by the filming process at least 48 hours in advance.
If required to do so, the production company (the permit holder) must provide a copy of the letter that has been letter
box dropped to the affected properties to Council.
The user will insure its sets, costumes, properties and equipment and all goods and materials of any kind brought into
the facility in connection with the event/activity. The user will provide Council with proof of such insurance upon
request.
Page 7 of 10
Application for Use of a Municipal Reserve
24. Keys
Where a key is required, for an approved use, this must be collected from the Customer Service desk, Gannawarra Shire
Council, Patchell Plaza, 47 Victoria St Kerang, (or other office by arrangement) on the last working day prior to booking. The
key must be collected, by prior arrangement, during business hours, 8.30am to 5pm. It must be returned the first working
day following the booking. A fully refundable key deposit of $50.00 per key is required.
25. Bollard keys
It is the Hirer’s responsibility to ensure that bollards are safe and secured after removal and they are returned and secured at
the end of the hire period. Council retains the right to invoice the Hirer the full cost of repair and/or reinstatement for any
loss.
26. Vehicles / parking
Vehicles may only be taken onto Council reserves and parks if the Permit specifically allows this. This approval is limited to
those vehicles essential for the conduct of the approved activity (e.g. wedding party, film crew, disabled access). The
Responsible Manager or an Authorised or Delegated Officer reserves the right to revoke this approval in certain weather
conditions.
27. Duty of care
All users have a Duty of Care towards any person attending the event/activity to ensure that the event is run in an orderly
manner and not place any person or property at risk to injury or damage.
28. Responsibility
The user of any Council facility is TOTALLY responsible for:
a)
The conduct of patrons at the event/activity, including patrons in unauthorised areas; broken glass; and/or undue
debris or foodstuffs within the facility.
b)
Reporting any incident that may lead to some action being brought against them or Council, in the course of the use of
the facility.
c)
Any damage to the facility, including damage caused by patrons.
d)
Reimbursement for any damages to, or cost of replacing missing property, will be deducted from the security
bond/refundable deposit.
29. Other
Any additional clause which an Authorised or Delegated Officer reasonably believes is relevant and based upon the individual
circumstances of an application may be appended to this list of terms and conditions.
30.
The user shall observe these Terms and Conditions of Use.
Page 8 of 10
Application for Use of a Municipal Reserve
GENERAL INFORMATION
Contact Council
Postal Address:
PO Box 287 Kerang 3579
Email: council@gannawarra.vic.gov.au
Kerang Office:
47 Victoria Street
Phone: 5450 9333
Fax: 5450 3023
Cohuna Office:
23 King Edward Street
Phone: 5456 5222
Fax: 5456 2173
Council Enquiries
Alcohol/Local Laws – Local Laws Team Leader
Bins and Rubbish Collection – Parks and Gardens Team Leader
Food Handling Regulations for Events – Environmental Health Officer
Marquee/Temporary Structure Erection/Building Permits – Municipal Building Surveyor
PA Systems/Emergency Access Requirements/Electrical – Special Projects Officer
Public toilets and number required based on crowd estimates – Municipal Building Surveyor
Road Closures/Barriers/Traffic Signs – Local Laws Team Leader
Insurance – Manager of Governance
Other Contacts
Ambulance - Emergency
Fire - Emergency
Policy - Emergency
Phone 000
Phone 000
Phone 000
Police - Cohuna (Market Street)
Police - Kerang (Albert Street)
Police - Koondrook (Main Street)
Police - Quambatook (Church Street)
Phone 5456 4150
Phone 5452 1955
Phone 5453 1555
Phone 5457 1200
Fire Brigade - Kerang Region (enquiries only)
Phone 5450 3406
Alcohol Consumption
Victorian Commission for Gambling and Liquor Regulation
http://www.vcglr.vic.gov.au/home/liquor/
1300 1 VCGLR (1300 182 457)
Insurance
Single cover Event Liability insurance may be available for one-off events, such as a fairs, street parties,
festivals, community celebrations, etc. not covered by a hirer’s current policy or by Council. For further
information visit www.localcommunityinsurance.com.au
Page 9 of 10
Application for Use of a Municipal Reserve
MUNICIPAL RESERVES IN GANNAWARRA SHIRE
COHUNA
Recreation Reserve
Garden Park
Fire Brigade Track
Apex Park
Donat Park
KANGAROO LAKE
Northern end
Gorton Point
Oval 1 / Oval 2 - Island Road COHUNA
King George Street COHUNA
King George Street COHUNA
Island Road COHUNA
Martin Place COHUNA
All reserves
KERANG
Atkinson Park
Reedy Lake
Wellington Street KERANG
Apex Park Road KERANG
KOONDROOK
Apex Park
James Park
Main Street KOONDROOK
River Parade KOONDROOK
LEITCHVILLE
Recreation Reserve
19 King George Street LEITCHVILLE
MURRABIT
Market site
Gonn Avenue MURRABIT
MYSTIC PARK
Recreation Reserve
Wilson Street MYSTIC PARK
QUAMBATOOK
Bev Nalder Memorial Park
Williamson Park
Guthrie Street QUAMBATOOK
Mildred Street QUAMBATOOK
Page 10 of 10