Parks & Reserves Memorial Application Please complete this form if you are planning a memorial event / scattering of ashes in a Town Park or Reserve area. Title*This field is required. Select an Option CO CR DR EST MISS MR MRS MS N REV U Given Name*This field is required. Surname*This field is required. Address*This field is required. Email Address*This field is required. Phone / Mobile Number*This field is required. I understand and agree that the gathering / ceremony must remain low-key*This field is required. YesNo I understand and agree that public access or use of the area will not be interferred with (the area remains open to the public). Parking bays are unable to be reserved or blocked off.*This field is required. YesNo I understand and agree that only ashes are to be released in the earth. Flowers or other memorial items should not be placed/left in the park or reserve.*This field is required. YesNo I understand and agree that ashes will be spread out (not in a pile) and lightly covered in soil away from the root system of plants, trees and lawn to minimise environmental impact.*This field is required. YesNo I agree that ashes will be scattered in a secluded area, ideally away from other people (note the wind direction) and avoiding main pathways.*This field is required. YesNo I have read, understood and agree to the General Conditions of Hire*This field is required. YesNo Proposed Park or Reserve for Memorial / Ceremony / Spreading of Ashes*This field is required. Proposed Date*This field is required. Proposed Start Time*This field is required. Proposed End Time*This field is required. Nature of Memorial (Spreading of ashes, gathering only etc)*This field is required. Proposed number of guests*This field is required. Comments Type the code from the image: Do not fill this textbox.