LGP Module – Licensing, City Laws Page 1 of 4

Busking Permit application Local Law No 9 (Parks and Reserves) 2008 Local Law No. 11 (Roads and Malls) 2008

Council of the City of Gold Coast ABN 84 858 548 460

PO Box 5042 GCMC QLD 9729 P 1300 GOLDCOAST

E mail@cityofgoldcoast.com.au W cityofgoldcoast.com.au

Please direct all enquiries and submit your application to the applicable agency below: (please tick applicable)

SURFERS PARADISE: BROADBEACH: SOUTHERN GOLD COAST:

Surfers Paradise Alliance Ltd 3/Surfers Paradise Transit Centre 10 Beach Rd SURFERS PARADISE QLD 4217 P 07 5584 3700 W surfersparadise.com E busking@surfersparadise.com

Broadbeach Alliance Ltd 2729 Gold Coast Hwy BROADBEACH QLD 4218 P 07 5656 0100 W broadbeachgc.com E bal@broadbeachgc.com

Connecting Southern Gold Coast Level 2, Suite 206, The Strand at Coolangatta 72 - 80 Marine Parade COOLANGATTA QLD 4225 P 07 5534 3500 W southerngoldcoast.com.au E info@southerngoldcoast.com.au

CBD (SOUTHPORT): BURLEIGH HEADS:

Mr Dale Dickson Chief Executive Officer City of Gold Coast PO Box 5042 GOLD COAST MC 9729 P 1300 GOLDCOAST E mail@cityofgoldcoast.com.au W cityofgoldcoast.com.au

Mr Dale Dickson Chief Executive Officer City of Gold Coast PO Box 5042 GOLD COAST MC 9729 P 1300 GOLDCOAST E mail@cityofgoldcoast.com.au W cityofgoldcoast.com.au

Please note the following:

The busking application form must be completed and received by the closing date for the next permit period. Please refer to the Surfers Paradise Alliance Ltd (SPA), Broadbeach Alliance Ltd (BAL) or Connecting Southern Gold Coast Ltd (CSGC) websites for closing dates, or contact the applicable office for details.

• Separate permit fees are required for Surfers Paradise, Broadbeach, Southern Gold Coast and Burleigh Heads. Application fees are not required for CBD (Southport).

• Fees are not required to accompany this application. Successful applicants will be advised of payment requirements.

Applicant details

Provide the full name of the applicant.

Applicant name

Postal address

Suburb

State Postcode

Email

Phone (mobile) Phone (b/hours)

Preferred method to receive correspondence Post Email

Contact person details

Provide details if contact person for approval is different from the applicant.

Contact name

Postal address

Suburb

State Postcode

Email

Phone (mobile) Phone (b/hours)

Preferred method to receive correspondence Post Email Busking details

Provide details of your busking performance below, ensuring all relevant information is provided.

Have you been issued a permit to busk in the city within the past 12 months? Yes No

Number of months you are applying for (max 12mths to 31st August following)

Performance times

Number of performers

Names of performers

Is any performer under 18 years of age (minor)?

Yes No

Age of minor/s Under 14 years old 14 to 17 years old

Busking entertainment details

Provide details of your busking entertainment below, ensuring all relevant information is provided.

Select whether your performance is amplified or not* Amplified Not amplified

Performance name

Performance description

Circus style performance Contortionist Comedy

Dance Instrument and vocals Instrument only

Mime/living statue One person band Vocals

Does your performance involve audience participation? Yes No

Does your performance involve animals? Yes No

Supporting information (please tick if provided)

Where a busking performance involves equipment, instruments, props or actions that have the potential to injure a person or damage property, you are required to supply evidence of your broadform public liability insurance. The policy must be for at least $10 million and note the interests of the Council of the City of Gold Coast, that is the following wording must appear: Interested Party: Council of the City of Gold Coast. Public liability insurance provided

Fees

Fees are not required to accompany this application. Successful applicants will be advised of fee and payment requirements.

Declaration (Adult over 18 years of age)

This section must be completed by, or for the applicant. Where a person is signing on behalf of a corporation or person (the ‘signatory’), they must occupy a position that is legally entitled to make that application and complete the details below. Documentation must be provided if a power of attorney (POA) signs on behalf of a person.

I understand and verify that: I am duly authorised to make this application The statements and information provided are accurate, true and complete I have received all relevant third party consents and authorisations It is an offence to knowingly provide false or misleading information Approval of this application does not extend to the approval of any other statutory or local government

requirements relating to this premises or activity

Applicant name

Signature Signatory name

Date Position/role Declaration (Minor under 18 years of age)

This section must be completed by, or for the applicant. Where a person is signing on behalf of a corporation or person (the ‘signatory’), they must occupy a position that is legally entitled to make that application and complete the details below. Documentation must be provided if a power of attorney (POA) signs on behalf of a person.

I understand and verify that: It is an offence to knowingly provide false or misleading information. I have read and declare that I understand the obligations and responsibilities as set out in the ‘busking

guidelines’ which form part of the terms and conditions of this application. The City and managing agencies do not provide supervision of buskers less than 18 years of age. Buskers less than the age of 18 may be required to take specified measures to maintain personal safety

when busking. The parent or guardian must ensure buskers less than 18 years of age when required by conditions of a

permit have parental supervision or have in their possession a signed authority provided by the parent or guardian of the busker indicating an approved supervisor who is at least 18 years of age.

Approval of this application does not extend to the approval of any other statutory or local government requirements relating to this premises or activity.

Parent/Guardian

Name

Signature Date

Applicant

Applicant name

Signature Date

Privacy statement

Council of the City of Gold Coast (Council) is collecting your personal information in order to provide the services requested, perform associated Council functions and services, and to update and maintain Council's customer information records. Your information is handled in accordance with the Information Privacy Act (Qld) 2009 and may only be accessed by Councillors, Council employees and authorised contractors. Unless authorised or required by law, we will not provide your personal information to any other person or agency. For further information go to cityofgoldcoast.com.au/privacy. Council may also use your personal information in order to contact you to provide you with information regarding Council functions and services. If you do not wish to receive such information please opt out using the unsubscribe link in the communication material sent to you.

Office use only

Date received Fee paid

Received by Receipt number