Park Vehicle Access Form

Park/Reserve Required *

Start Date *

Name of contact person *

Contact number *

What type of vehicle(s) will be drive across the park/reserve? *

Distance to travel into the park/reserve *

End Date *

Address *

Email *

Why is vehicle access required across the park/reserve? *

Could the general public be exposed to works? *

Yes

No

What protective measures will be put in place to minimise risk?

Is this a company applying? *

Yes

No

If a company is applying, two directors (or the sole director/secretary if applicable) need to sign this form and copy of public liability insurance to be attached.

Public Liability Insurance *

Declaration

I agree to indemnify the Town of Claremont from and against all claims, demands, costs, losses, damages, expenses whether at law or in equity arising out of or in connection with or related to the access to or use of the park/reserve. I agree that I am not covered by the Town's public liability insurance and proceed at my own risk. I have read and understood the terms and conditions detailed in the Use of Reserves Policy (EN307- see www.claremont.wa.gov.au) of the Town of Claremont. I understand that this is only an application and I will await confirmation before proceeding. *

Signed *

Title *

Date *

Signed

Title

Date

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Park Vehicle Access Form

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