Fee waiver application form

FEE WAIVER APPLICATION FORM

Council's General Manager will make all decisions on fees that are to be waivered. All requests must be received at least 14 days prior to booking. For further information or questions regarding this form, please contact Council via 9911 6555.

Applicant Details

Organisation Name

Title *

First Name *

Surname *

Address *

Suburb *

Postcode *

Phone (m) *(e.g. 04XX XXX XXX)

Email *

Eligibility for requesting fee reduction or waiver

Under section 610E of the Local Government Act 1993, Council may waive or reduce a fee in a particular case if Council is satisfied that the case falls within any category in respect of which Council has determined payment should be so waived or reduced. Council has established the categories below which may apply to fees in relation to venues for hire/open space bookings (Please select what applies to your request):

Categories *

Registered not-for-profit or a charitable organisation that provides identifiable social benefits that respond to community needs Unincorporated community organisations or other organisations that provide identifiable social benefits that respond to community needs Generate donations on behalf of, and/or for provision to, charitable fundraising authority holders where it is demonstrated that all revenue exceeding costs of the specified activity is donated (for example, facility hire for disaster recovery events).Recognise and/or celebrate the achievements of an entity within the City of Canada Bay General Filming: In accordance with the Local Government Filming Protocol 2009 to be determined by application only

Evidence of registered not-for-profit or charitable organisation status: *

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Please upload proof of charitable fundraising authority *

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Booking Details

Please select what the fee waiver is for: *

Park/Sports fieldVenueConcord Oval Recreation CentreFive Dock Leisure Centre

Please provide information on why you are requesting a fee reduction or waiver: *

Please describe the social benefits that respond to community needs *

Quote Booking number *

Location *

Do you have multiple dates? *

YesNo

What is the cost of participation? *

Participation is free Participation is covered under an annual membershipParticipation requires a fee

Date *

Please provide a list of dates *

Details of booking *

Please attach any supporting documentation that will assist in the decision to waive part or all of the applicable fees

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Please note you can upload multiple files

Have you previously applied for a fee waiver? *

YesNo

Was the application approved? *

YesNo

Level of fee reduction requested

25% Reduction50% Reduction 75% reductionFull Fee Waiver

Resident participation

What percentage of City of Canada Bay Council residents and non resident's participation is your booking aimed at?

CCBC Residents *Suburbs in City of Canada Bay Council are: Abbotsford, Breakfast Point, Cabarita, Canada Bay, Chiswick, Concord, Concord West, Drummoyne, Five Dock, Liberty Grove, Mortlake, North Strathfield, Rhodes, Rodd Point, Russell Lea and Wareemba.

Non Residents *

Applicant Declaration

In signing this form, I agree to pay all relevant fees immediately upon Council's decision and agree to acknowledge Council's assistance regarding any fee waiver and/or reduction in production credits and other promotional material related to the activity. The information provided on this form is true and correct. If there are any changes to my booking, I will notify Council immediately.

Applicant Signature *

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Date *