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APPLICANT DETAILS Approval Number………………… Contact Name …………………………………………………………………………..… Address ………………………………………………………………………………….… Phone ………………………………….. Email…………..……………………………… ACTIVITY DETAILS Type of busking (eg. playing a musical instrument, singing, dancing, etc) …………………………………………………………………………………………..….. Type(s) of musical instruments ………………………………………………………… Is amplification proposed? Yes / No Number of persons involved …………………………………………………………… Location of busking activity ………….……………………………….……………… As a courtesy, have you contacted the adjoining shop owner to inform them of your intention to busk? Yes / No Did the shop owner have any objections? Yes / No Is the location within the footpath walkway zone? Yes / No If Yes, will the busker(s) be located away from shop entrances? Yes / No and will there be a minimum of 2.7m between the busker(s) and the kerb? Yes / No Dates and times of operation of busking activity …….…………………………… ……………………………………………………………………………………………….. Note: Council will generally limit busking approvals to periods of no more than one month to ensure access to busking locations for a range of users. Approvals will expire at the end of the period stated in the approval, and a further approval will then be required. INSURANCE DETAILS Is evidence of public liability insurance to the value of $20M provided? Yes / No APPLICANT’S SIGNATURE ………………………………………. DATE ………….

BUSKING APPROVAL APPLICATION FORM

Eurobodalla Shire Council PO Box 99, Moruya NSW 2537

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OFFICE USE ONLY The Application is: (please circle) Approved Refused APPROVAL CONDITIONS (Cross out if not applicable)

This approval is issued subject to the following conditions: 1. This approval is valid only for the dates specified on page 1. 2. The use of dangerous materials or animals in the busking activity is not permitted. 3. The busking activity must not unduly obstruct the footpath. Objects used for the

collection of money must not be located in a manner that obstructs pedestrian movements along the footpath.

4. The busking activity must not be undertaken away from the approved location. 5. The busking activity must not cause any harassment of the general public. 6. Buskers shall perform for a maximum of 2 hours on any one day. 7. Amplification, if proposed, is approved on a trial basis only. Council reserves the

right to amend this approval to refuse amplification where there are justified complaints regarding excessive noise.

8. This approval may be revoked at any time if the conditions are not complied with or if the amenity of persons is detrimentally affected for reasons of noise, health or safety.

9. Other Conditions: ……………………………………………………………………………………………... Signed:…………………….……… Date:………………

Print Name ………………………………………………. ----------------------------------------------------------------------------------------------------------------------

REFUSAL REASONS (Cross out if not applicable)

The application is refused for the following reasons: 1. The proposed activity does not comply with the Street Activities Policy. 2. The proposed activity does not comply with the Street Activities Code of Practice. 3. The proposed activity will unduly obstruct the footpath. 4. Evidence of public liability insurance has not been provided. 5. Other reasons:

…………………………………………………………………………………………………….. Signed:…………………………… Date:……………….

Print Name ………………………………………………

BUSKING APPROVAL APPLICATION FORM

Eurobodalla Shire Council PO Box 99, Moruya NSW 2537