Parks & Reserves Memorial Application Privacy The Town of East Fremantle is collecting your personal information for the purpose of responding to your request. Some of the information may be provided to Town Contractor's for the purposes of addressing your request. Your information will not be provided to any other person or agency unless you have given us permission, or where legally obligated to do so. If you would like to know more about how the Town handles your personal information please see the Town's Privacy Statement and Collection Notice. ------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 * Required Field. Given Name*This field is required. * Required Field. Surname*This field is required. * Required Field. Address*This field is required. * Required Field. Email Address*This field is required. * Required Field.* Enter valid email address Phone / Mobile Number*This field is required. * Required Field.* Enter valid phone number I understand and agree that the gathering / ceremony must remain low-key*This field is required. YesNo * Required Field. 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 * Required Field. 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 * Required Field. 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 * Required Field. 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 * Required Field. I have read, understood and agree to the General Conditions of Hire*This field is required. YesNo * Required Field. Proposed Park or Reserve for Memorial / Ceremony / Spreading of Ashes*This field is required. * Required Field. Proposed Date*This field is required. * Required Field. Proposed Start Time*This field is required. * Required Field. Proposed End Time*This field is required. * Required Field. Nature of Memorial (Spreading of ashes, gathering only etc)*This field is required. * Required Field. Proposed number of guests*This field is required. * Required Field.* Enter valid number Comments Type the code from the image: Do not fill this textbox.