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About this form

You may use this form to apply for approval to busk within the City of Sydney Council Local Government Area under s68 of the Local Government Act 1993. * If you use dangerous materials in your act, you must also attend a Safety Review audition with the City or Australian Circus & Physical Theatre Association (ACAPTA) * If you are under 18 years of age your parent or guardian must complete and sign Part 6 of this form and be present when you apply for your permit. * Each member of a group act must submit a separate application. * All buskers must read the City of Sydney Interim Busking Policy and Interim Busking Guidelines 2011 (includes Pitt St Mall Pilot) before they submit this form. * Any approval will be issued subject to conditions.

How to complete this form 1: Ensure that all fields have been filled out correctly. 2: Please note that fields on this form marked with an * are mandatory and must be completed before submitting the application. 3: Forms must be submitted in person. Please refer to the Lodgement details section for further information.

Busking Permit Application

TRIM2011/088522 V01-18

Part 1: Applicant DetailsFamily Name * .Given Name/s *.Title *.

Mobile Number * Phone Number *

Postal Address

Email Address*

NoYesWould you like to be contacted by Email about promotions,

festivals, busking policy changes and performance opportunities?

Note: Before this application can be lodged at least one of the points of telephone contact below must be supplied. *

Part 3: Sale of merchandise

No

I declare that any CDs or DVDs which I sell will only contain

my own, original material.

YesDo you intend to sell CDs or DVDs related to your performance?

If yes, please read and sign the declaration below.

Signature

Part 2: Type of Busking Permit

Please indicate the type of permit required:

Are you renewing a permit or applying for a new permit? New Permit Renewal

Standard Special Aust. Circus & Physical Theatre Assoc. (ACAPTA Accredited)

Annual Permit ($47.00) Quarterly Permit ($13.00)

Previous Permit number: NOTE: Additional fees payable for Special

permit safety review.

Office Use Only

City of Sydney Busking Permit Number Receiving Officer

Date application received/issue

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Part 5: Parental/Guardian Consent Details (if applicant is under 18)

Performing as a busker in the City of Sydney Local Government Area.

I understand that:

1. the City of Sydney provides no supervision of Buskers under the age of 18 years and recommends an adult

accompany young buskers at all times.

2. buskers under the age of 18 are subject to the City of Sydney Interim Busking Policy 2011 and will ensure the

busker complies with the guidelines of the Interim Busking Policy at all times.

I (please print name)

Date* Parent/Guardian Signature* Parent/ Guardian Name (please print)

Of ( please print address)

Hereby consent to my child or ward ( please print name of child or ward)

A parent or guardian must be present when application is made.

Part 6: Proof of Identity

You must provide Council with proof of your identity, and proof of identity of your parent / guardian if you are under 18 years. Please tick the item/s below which you will provide as proof of identity.

Proof of Age Card:

Drivers Licence - provide details below

Other type of ID #

Current Passport

You Your Parent/Guardian (where applicable)

Type of ID card (Only Australian ID cards accepted)

Proof of Age Card State of issue -

Drivers Licence No.(you or guardian)

Please Note: Documents that are not in English, such as overseas Drivers' Licences, must be accompanied by a full English

translation of the document. # Types of ID Cards accepted: ID containing a signature, a recent photograph and date of birth such as Military ID document, Student ID card, Air Crew Identity card / document, Seafarer ID card / document and ID from major institutions will be accepted, at the discretion of the receiving officer.

Passport number

Part 4: Performance Details

Yes No

Performance Description

Please specify which instrument(s) you will play

Dangerous Act >

Instrumental >

Pavement art (chalk only) Dance

Mime / StatueContortionist

One man bandVocals

ComedyJuggling (non-dangerous implements)

Please select the type of performance by ticking the applicable box/es below

Please note, you will need to pass a Safety Review before a licence can be issued. Bookings for reviews with the City of Sydney can be made over the phone (02 9265 9333) or for national accreditation, please contact ACAPTA on (03) 9329 9600.

Will your performance be amplified? (If yes, please note only battery powered amplifiers are allowed)

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Part 9: Lodgement Details

You must lodge the completed application by attending Council with your application form and any supporting documents. If the requirements for a busking permit are met, a photograph will be taken for the purposes of issuing a busking permit. You can obtain a busking permit from any of the following locations. IN PERSON: CBD: Kings Cross: Glebe:

Green Square

Redfern:

What now:

A Council Officer will discuss your application at the time you attend Council and an approval, including a copy of all applicable conditions, will be issued if the requirements for a busking permit are met. If you need to book a safety review for a special busking permit, please contact the One Stop Shop in person or by phone. For further information regarding your application please contact us by: TELEPHONE: (02) 9265 9333 or visit our WEBSITE: www.cityofsydney.nsw.gov.au

Level 2, 456 Kent Street, See website for current opening hours 50-52 Darlinghurst Road, See website for current opening hours 186 Glebe Point Road, See website for current opening hours 100 Joynton Avenue, See website for current opening hours 158 Redfern Street, See website for current opening hours

Part 7: ACAPTA Accredited Busking Permit - if applicableIf you have already attained ACAPTA ( Aust. Circus & Physical Theatre Assoc.) accreditation, provide the permit details below:

Date Assessed:

Location:

Assessor's Name:

Description of Act:

Implements approved: National Accreditation Card No.:

$10 Million Insurance policy details:

Policy No.:

Expiry Date:

Insurer:

I agree to comply with the following conditions of approval: * I will display my City of Sydney Permit to Busk in a prominent position close to where I am performing at all times. * I will make my Permit available for inspection by an authorised officer of Council upon request and follow any lawful direction issued by that officer. * I will not transfer this Permit to any other person. * I agree that this Permit does not give me sole use or reservation of a site and it does not guarantee a regular income. * I will use designated sites in restricted areas in accordance with the conditions attached to their use and contained in the City of Sydney Interim Busking Policy and Interim Busking Guidelines 2011 (includes Pitt St Mall Pilot) - available on the City's public website: http://www.cityofsydney.nsw.gov.au/council/our-responsibilities/permits-and-notifications/busking * I will not create a threat to public safety, whether real or perceived. * I will not engage in any commercial activity, other than selling my own CD's. * I will notify the City of Sydney if my personal details or my performance changes to include the use of any dangerous implements not specifically listed in the "Assessment of Competency in Dangerous Performance" section of this form (if applicable). * I have received and read the City of Sydney Interim Busking Policy & Guidelines 2011 and agree to be bound by the conditions contained in the Policy. Date*Applicant Name* Applicant Signature*

Part 8: Conditions of Approval

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Date Assessed Location

Description of Act reviewed

Office Use Only - Assessment of Competency in Dangerous Performance

Part 10: Privacy & Personal Information Protection Notice

Purpose of Collection: For assessment of eligibility for a permit to busk in the City of Sydney Local Government area. Intended recipients: Council staff and approved contractors of the Council of the City of Sydney. Supply: Voluntary, however a completed application is required to apply to conduct busking activities in the City of Sydney Council area. Access / Correction: Contact the City of Sydney Council Customer Service Team to access or correct this information. Storage: City of Sydney Council, 456 Kent Street Sydney NSW 2000.

Equipment

Performance space is well marked and appropriate for the type of performance? (e.g. rope/chain, distance from audience etc.)

Equipment safely erected or placed and managed within the space throughout the performance?

Is the equipment in good repair?

List of equipment inspected:

Has the equipment been safely packed for transit? (Fuel stored in separate bag, spillage and contamination of items stored together, could it break or collapse, is the weight suitable for carrying?)

Busker has appropriate safety equipment? (i.e. fire blanket, fire extinguisher, wet towel for personal and equipment use, first aid kit, clean water)

Is the safety equipment in good repair and within expiry dates?

Performance Safety Procedures

Does busker have the necessary skill level to safely present the performance in a pubic environment (e.g. can they juggle and keep an eye on the audience)

Can the busker demonstrate the safe use of their performance equipment in the established space? (i.e. blades away from children, fuel containers stored away from flames, structures used safely with adequate space to fall within the buskers circle, equipment dismantled safely)

Busker has appropriate strategies to deal with interruptions from the public (i.e. people walking through space, hecklers and managing excessive crowds etc.)

Yes

Yes No

NoYes

No

No

Yes

Yes No

Yes

No

No

Yes

Yes No

Yes

No

Comments / Reason(s) for decision

Application Approved Application Refused (Please state reason(s) in comment box below)

Busking Peer Assessor Name & SignatureCouncil Cultural Assessor Name & Signature

We, the undersigned, hereby agree that the following applicant (print name of applicant) has been assessed by us on (insert date) and possesses / does not possess (cross out whichever is not applicable) the appropriate skills and knowledge in the use of the dangerous materials or equipment listed on this form to obtain a Special Busking Permit to perform with the specified materials / equipment in the City of Sydney Local Government Area.

Assessors' declarations