You are on page 1of 5

Application for Facility Allocation – Community Facilities 2017

This form is to be completed by new and existing groups seeking tenancy in one of Council’s civic or
community facilities. This is open to incorporated groups, clubs, associations and businesses
seeking to be involved in a tenancy with Council for activities and programs with a minimum of 6
bookings across a 12 month period in 2017.

1. Details of group / club / association / organisation:

Organisation /
Group Name ABN / ACN

Address (please
do not fill Council
facility address) P/Code
Contact Person
Contact Position
Contact Phone Work Mobile*
E-mail Website
Please TICK if you wish to receive information from Melton City Council via SMS to your
*☐ nominated mobile phone. You may opt out at any time by replying “STOP” to the text
message you have received.
I agree for my activity and contact details to be promoted through Council publications / notice
☐ boards.

2. Insurance and incorporation: (if YES, please provide copy of relevant documentation)

Does your group have minimum $20million public liability insurance? ☐ Yes ☐ No

Is your group incorporated? ☐ Yes Cert #: ☐ No
Is your group a registered training organisation? ☐ Yes RTO #: ☐ No
Is your group a Community Service Organisation / Agency that
receives funding to run programs? ☐ Yes ☐ No

Does your group charge fees to members? ☐ Yes ☐ No

If YES, how much and for what?

Does your group / organisation have a license to operate a children’s
service / program* (if applicable)?
☐ Yes ☐ No

+
Do your staff / volunteers have a Working with Children Check (if
applicable)?
☐ Yes ☐ No

*Please refer to the Children’s Services Act 1996 to determine if you are required to have a licence
to operate a children’s service / program.
+
Please refer to the Working with Children Act 2005 to determine if you are required to have a
Working with Children Check.

Page 1 of 5

Please note that for some venues. Description of activity: (for commercial groups.vic. please provide all relevant details to support this) 8. If currently operating. Number of participants and age group: (please indicate quantities) Newborn – preschool 25 years – 35 years 5 years – 12 years 36 years – 50 years 13 years – 17 years 50+ years 18 years – 24 years 6. 3. = first preference) 1. 2.3. How many participants (from section 4 above) reside in the City of Melton? Number of participants % of participants 7. **Please refer to Council’s website for list of venues for hire http://www. For further information. please list as in business registration) 4. where from and how often: 5. please contact Council’s Venues Team on 9747 5200.au/Out-n- About/Community-facilities/Venues-for-hire. Outline your reason for seeking access to a community facility? 9.gov. access criteria may apply. Community facility preference** (please list the three preferred facilities – 1.melton. Page 2 of 5 . Do you have any evidence of growth of your existing program/s? (if YES.

e.10. equipment. Days / Times / Usage etc. Do you have any additional comments for consideration to support your application? Page 3 of 5 . Storage space is limited and strictly subject to availability) 11. Does your activity operate: (please tick  one) ☐ By school terms ☐ School holidays only ☐ Unknown /demand based 13. Preferred usage requirements: (i. Which category best describe your group? (please tick  one) ☐ Commercial ☐ Community / Not for Profit ☐ Community Service Organisation 12. Does your activity have any special needs request? (i. floor surface. Preferred start date: (please allow minimum 4-6 weeks processing time) 15. Do you have any relevant references / documentation to support your application? (please list and attach) 17. Please tick YES or NO. storage – please list items. in reference to your submission being referred to another venue if preferred venues are unavailable: ☐ YES ☐ NO 16.) Days Start Time End Time Usage Other Details Hours Monday Tuesday Wednesday Thursday Friday Saturday Sunday Total hours per week 14.e.

Venues Team will advise the outcome of your application in writing. Melton VIC 3337 OR hand delivered to the following locations:  Melton Civic Centre  Melton Library & Learning Hub 232 High Street.au OR posted to: Venues Team (Neighbourhood Participation) Melton City Council PO Box 21. For office use only: Received: AFA Records: Enter bookings: Email list of dates: Copy to ECM: L/A Prepared: L/A Sent: Page 4 of 5 .vic. Applications can be scanned and emailed to: venues@melton. Melton 3337  Caroline Springs Civic Centre / Library 193 Caroline Springs Blvd.gov. Melton 3337 31 McKenzie St. Tick boxes to ensure that you have included all required information: ☐ Completed / circled dates on calendar (mandatory) ☐ Copy of current public liability insurance of minimum $20million (mandatory) ☐ Certificate of incorporation (if applicable) ☐ Copies of relevant licences / accreditation / Working With Children Checks (if applicable) ☐ RTO Training Plan (if applicable) Thank you for completing the application for facility allocation. Applications will only be considered when all relevant supporting documentation has been provided. Caroline Springs 3023 Applications will be processed in line with Council’s Community Facility Access policy.

Page 5 of 5 .

Related Interests