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Online Form - South Hedland Town Square Community Event Application Package

Applicant Details

Event Details

Please mark the type of booking you require*

Please give a detailed description of intended use, as this will be the legally Permitted Purpose of your facility use.

If you can demonstrate achievable outcomes and clear benefits for the Town of Port Hedland from this event, you may be eligible for community funding or in-kind support. Please consult the Town of Port Hedland’s Donation Policy for more information.

Have you organised an event of this type in the past?*
Will there be any sound amplification at the event (e.g. live music, PA announcements, recorded amplified music etc)?*
Is the event being advertised or promoted?*
Will food or drinks be sold or provided?*

If yes, please complete the Application or Temporary Food Premises form. If more than 1 vendor, each will need to complete individual forms or apply for a blanket licence. For more information please contact the Environmental Health Officer on 9158 9367 or

Is this event an under 18’s event?*


NOTE: No ground marking, star pickets or tent pegs permitted for any of the above.

Equipment continued

Do you require power if available?*

Minimal power is available onsite. If you require additional power sources you will be required to organise these yourselves.

Do you require the nightly watering system to be turned off during this event?*
Will you be using pyrotechnics at the event?*

Max File Size: 10.00 MB
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Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

Public liability insurance is mandatory for all events organised by sporting clubs, associations, and incorporated bodies, as well as for any events designed to make a profit. The insurance cover must be to the value of $10 million and must note the ToPH as an interested party. Hirers must provide the ToPH with copies of their current insurance policy at the time of making this Application. If the event is a private function booked under a personal name, public liability insurance is not required.

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx

You are required to provide a Risk Management Plan for events with over 500 people or as requested by the ToPH’s Environmental Health Department.

Will you be requiring public road closures?*
If YES please select type of road closure

Max File Size: 10.00 MB
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Have you organised security personnel / crowd controllers?*
Have you notified the following emergency services of your event?*

Hirers are required to advise the following emergency services of their event:

South Hedland Police Station
9160 2100

St John’s Ambulance Service
9172 1333

South Hedland Volunteer Fire and Rescue
9172 3176

Have you organised extra toilets?*

Note: The information extracted from this document is to be used as a guide only. It is the responsibility of the applicant to ensure that all approvals from other agencies (e.g. Police, Main Roads) are received in relation to each particular event.

Site Plan

  • Stage
  • Seating
  • Vehicle Access Points
  • Food Stalls
  • First Aid Posts
  • Marquees, tents
  • Electricity cables
  • Emergency exits
  • Parking areas
  • Fenced off area
  • Additional toilet facilities
  • Site signage
  • Areas for sale or consumption

Click here to downlaod a copy of the site plan template.

Max File Size: 10.00 MB
Allowed File Types: .avi, .doc, .docx, .gif, .jpeg, .jpg, .mov, .mp3, .mp4, .mpeg, .mpg, .pdf, .png, .ppt, .pptx, .xls, .xlsx


I/We have read, understood and agree to abide by the Terms and Conditions of Hire located on the ToPH Website. I/We agree to indemnify the ToPH against all actions, claims, demands, or costs arising out of connection with the hire of the facility. In consideration for the use of facilities owned by the ToPH, I/we agree to hold the ToPH harmless for any damages, acts or incidents that occur as a result of the above event held by me/us. Further, I/we assume all liability for specific losses arising from the event listed above and release the ToPH from all liability and costs incurred arising from or incident to the event. I/We also acknowledge that during cyclone season in the event of a warning or alert my/our booking arrangements may be compromised.
By signing below, you warrant that you have the appropriate authority to sign for and on behalf of the Hirer.

Before submitting this application please ensure you have completed the check list below!

Please check the following
I have included all required documents and permits including:

PLEASE NOTE: This is an application form only. Bookings are not confirmed until approval has been granted by the ToPH and either that payment of all fees has been received, or that we have invoiced for the fees and received a purchase order for these.

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