City of Whitehorse - Filming and Stills Photography Application Form

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Film and Stills Photography Permit Application

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Contact Information and Production Details

Name of applicant (key contact):

Contact's position title:

Name of production company/agency:

Phone number/s:

Email:

ABN:

Address:

Date/s of filming:

Weather hold date/s of filming (if applicable):

Time of crew arrival:

Time of crew departure:

Location of filming:

Product/production title:

Type of filming (stills/film/TVC/TV series etc.):

Proposed activities (description of action):

Number of crew/cast:

Number of production trucks and size:

Number of production cars:

Will you require a unit base location? If so, please specify:

Are you planning on erecting tents or marquees?:

Name of traffic/saftey management company (if required):

Does the filming contain firearms/car accidents/other safety issues? If so, please specify:

Any other activity that may cause public concern? If so, please specify:

Upload Supporting Documents

Public Liability Insurance Documents:

Pedestrian/traffic management plan:

Site map:

Parked vehicles map:

Risk assessment:

Other supporting documentation:

Checklist

Have you done the following?:

Have you done the following?
	Yes	No	N/A
Attached a copy of your public liability insurance	Attached a copy of your public liability insurance, Yes:	Attached a copy of your public liability insurance, No:	Attached a copy of your public liability insurance, N/A:
Completed a risk assessment	Completed a risk assessment, Yes:	Completed a risk assessment, No:	Completed a risk assessment, N/A:
Attached a pedestrian management plan or traffic management plan	Attached a pedestrian management plan or traffic management plan, Yes:	Attached a pedestrian management plan or traffic management plan, No:	Attached a pedestrian management plan or traffic management plan, N/A:
Included a site plan of the location you wish to film at	Included a site plan of the location you wish to film at, Yes:	Included a site plan of the location you wish to film at, No:	Included a site plan of the location you wish to film at, N/A:
Attached a map indicating location of parked vehicles, and applied to book parking bays if required	Attached a map indicating location of parked vehicles, and applied to book parking bays if required, Yes:	Attached a map indicating location of parked vehicles, and applied to book parking bays if required, No:	Attached a map indicating location of parked vehicles, and applied to book parking bays if required, N/A:
Sent letters to surrounding residents and/or traders advising them of filming activities (copy of the letter needs to be attached)	Sent letters to surrounding residents and/or traders advising them of filming activities (copy of the letter needs to be attached), Yes:	Sent letters to surrounding residents and/or traders advising them of filming activities (copy of the letter needs to be attached), No:	Sent letters to surrounding residents and/or traders advising them of filming activities (copy of the letter needs to be attached), N/A:
Contacted the Victorian Police Film and Television Office (if filming involves roadways or firewarms)	Contacted the Victorian Police Film and Television Office (if filming involves roadways or firewarms), Yes:	Contacted the Victorian Police Film and Television Office (if filming involves roadways or firewarms), No:	Contacted the Victorian Police Film and Television Office (if filming involves roadways or firewarms), N/A:
Contacted other government bodies who may have jurisdiction over the location/s (e.g. Parks Victoria, Melbourne Ports, private businesses)	Contacted other government bodies who may have jurisdiction over the location/s (e.g. Parks Victoria, Melbourne Ports, private businesses), Yes:	Contacted other government bodies who may have jurisdiction over the location/s (e.g. Parks Victoria, Melbourne Ports, private businesses), No:	Contacted other government bodies who may have jurisdiction over the location/s (e.g. Parks Victoria, Melbourne Ports, private businesses), N/A:
Provided other relevant information you would like to add to this application	Provided other relevant information you would like to add to this application, Yes:	Provided other relevant information you would like to add to this application, No:	Provided other relevant information you would like to add to this application, N/A:

Indemnification

The production company agrees to indemnify Whitehorse City Council against all claims or suits of any kind whatsoever against Whitehorse City Council for loss, damage or injury of any kind arising of the negligence or unlawful conduct of the production company and its employees, agents or otherwise. The production company agrees to comply with all the local laws of Whitehorse City Council and all other relevant legisation, council conditions, guidelines and special conditions provided.

Do you agree to the indemnification statement above?:*

Terms and Conditions

I have read and understood the City of Whitehorse Filming and Stills Terms and Conditions.

Do you agree to adhere to the terms and conditions?:*

Privacy Statement

The personal information requested on this form is being collected for the purpose of assessing the Film and Stills Photography Permit Application. The information will be used soley by Council for that primary purpose or directly related purpose and will not be disclosed to any other party except as required by law. The applicant understands that the personal information provided is for the above mentioned purpose and that they may access the information by contacting Council's Administration and Events Officer on 9262 6352.

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