Online Form - 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* Select an Option CO CR DR EST MISS MR MRS MS N REV U Given Name* Surname* Address* Email Address* Phone / Mobile Number* I understand and agree that the gathering / ceremony must remain low-key* 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.* 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.* 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.* 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.* YesNo I have read, understood and agree to the General Conditions of Hire* YesNo Proposed Park or Reserve for Memorial / Ceremony / Spreading of Ashes* Proposed Date* Proposed Start Time* Proposed End Time* Nature of Memorial (Spreading of ashes, gathering only etc)* Proposed number of guests* Comments Type the code from the image: Do not fill this textbox.