Online Form - Blender Bike Hire Application

Introduction

Navigate through the different form sections using the navigation on the left, or use the next/previous buttons located at the bottom of each step.

Save Your Progress

You have the ability to save this form and complete it at a later date. An email will be generated and sent to the specified address.

Email Address:

Password:

There is no way to resend or recover your password, please write it down.

Note: Incomplete forms are kept for a period of 2 day(s), after this time the system will automatically delete your response.

First name*

Last name*

Phone*

Email*

Address

Street Address:

City:

State:

Post Code:

Country:

Name of Organisation or Group

Please Select One

Commercial Business
Community Group
Charity Organisation
Resident
Other

ABN (if applicable)

Event name

Event dates

Event location

Event times

Please provide a brief description of what you will be using the bike for (eg: fundraising).

Please provide a list of all ingredients used

Blender bike collection date

Blender bike return date

Have you or your staff completed any food-hygiene training?

YesNo

If yes, what is the name of the course and what date was it completed?

If you have not completed any training, the Town of Victoria Park offers free online training called I’m Alert - victoriapark.imalert.com.au

How will potentially hazardous and perishable foods be transported to the event?

Refrigerated food vehicle
Esky with ice/ice packs
Mobile coolroom/freezer

How will potentially hazardous and perishable foods be stored on-site?

Refrigerator/freezer
Esky with ice/ice packs

Cold foods must be kept below 5°C at all times.

How will all unpackaged food products be stored on-site to protect them from contamination?

What will be your water supply?

What is your waste-water disposal method?

What is your water disposal method?

What type of handwashing facility will be provided within the temporary food premises?

Tap-operated potable water container with waste-water bucket

What type of dishwashing facility will be provided within the temporary food premises?

Tap-operated water storage container, wash bucket and waste-water bucket

Public liability insurance

The Town of Victoria Park requires that organisations, incorporated community groups and schools using Council’s reserves, facilities and equipment supply the Town with a current copy of an insurance Certificate of Currency for public liability to the value of $10,000,000 (ten million dollars).

Terms and conditions

The Town of Victoria Park has made this equipment available to support your organisation or community group to encourage healthy fundraising activities. The Town of Victoria Park can only keep this service going through your cooperation in adopting the following conditions of use.

All bookings are subject to the Town of Victoria Park local laws and regulations.
The equipment must only be used for its intended purpose as outlined in this booking form.
The equipment or any part of it cannot be lent to a party external to this agreement without expressed permission from the Town of Victoria Park.
The hirer is responsible for the full replacement cost at retail price for the equipment if it is lost, stolen or damaged beyond repair. The Town of Victoria Park will be notified immediately on the hirer becoming aware of the loss, damage or theft of the hired equipment.
The equipment is not to be used in any way that misrepresents the Town of Victoria Park.
The hirer is required to complete any relevant evaluation forms provided and return them to the Town of Victoria Park within seven days of equipment return date advised on this form.
The hirer will arrange a suitable time to collect and return the equipment to the Leisurelife Centre. The hirer will pay relevant hire fees and charges, provide proof of identity (driver’s licence) and will undertake an inventory check upon return of the equipment to the Leisurelife Centre.
The hirer will practice safe handling practices when moving, loading and unloading the bike.
Non-observance of the Town’s terms and conditions relating to the equipment, or Council by-laws, may result in immediate rescinding of the hirer’s contract and may jeopardise any future applications.
The bike must be stored indoors overnight and not be used during wet weather conditions.
It is the responsibility of the hirer to ensure appropriate cleaning/food safety methods are applied during use.
The bike and associated equipment must be returned fully washed and in the same condition it was in upon collection.
A bond will not be applied to the hire of the blender bike; however, the hirer will be directly invoiced for the cost of any damages or missing equipment.

Terms and conditions acknowledgment*

I have read and understand the terms and conditions

I accept responsibility for ensuring compliance with local laws and conditions pertaining to the use of Council property on behalf of the above named organisation/group.*

Yes, I accept.

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