Expression of Interest
Timbarra Community Stadium
Allocation Request /
This information will be used for the purpose of collecting details from new sporting clubs wishing to access the Timbarra Community Stadium for seasonal allocation within the City of Casey.
Submitting this form does not guarantee access to thefacility however it will provide vital information for future developments or proposed sporting facilities.
This information will be kept on file, and should a suitable sporting facility become available, clubs will be notified and invited to apply for an allocation.
Please assist the City of Casey by providing the information requested below as accurately as possible.
Contact Information
Organisation:
Postal Address:
Postcode:
Contact Name:
Position:
Phone (BH): / Mobile:
Email:
Website:
Club Information
Sport:
What age groups does your club/organisation offer? / Junior Senior
Is the club/organisation incorporated? / Yes No g
If yes, what is your incorporation number?
Does your club have public liability insurance? / Yes No g
Is your club currently associated with a State Sporting Association? (ie. BasketballVictoria, etc) / Yes No g
What league does your club currently participate in?
Membership
Total number of teams:
Total number of current members:
Percentage of players who live within the City of Casey:
/ City of Casey
Expression of Interest
Timbarra Community Stadium
Allocation Request /
At which facility does your club currently participate in sport? (Please include any facility outside the City of Casey.)
What are your clubs’ facility requirements? (ie. No. courts, community room, kitchen amenities)
Privacy Statement
Personal Information collected by the City of Casey/ Timbarra P-9 College is used for stadium hire purposes as specified in the Local Government Act 1989. The Personal Information will be used solely by the City of Casey/ Timbarra P-9 College for these purposes or directly related purposes. The City of Casey/ Timbarra P-9 College may disclose this information to other organisations if required by law/legislation or consent is given. The applicant may apply for access and/or amendment to the Personal Information. Request can be made to Council’s Privacy Officer.
As a delegate of the organisation listed above, I acknowledge that this expression of interest is not a guarantee seasonal allocation to the Timbarra Community Stadium. I also acknowledge and confirm that the information provided is true and correct at the time of submission.
Name: / Position:
Signed: / Date:
Please return this form to:Timbarra P-9 College
Address: Parkhill Drive, Berwick 3806
Postal: PO Box 2255 Fountain Gate 3805
Or email to:
Office Use Only:Information received date:
Other details attached:
Follow up required:
Date:
Notes:
1
Timbarra Community Stadium - Expression of Interest.doc