REGISTER A HEALTH PREMISES AT FALLS CREEK

Section 71 of the Public Health & Wellbeing Act 2008
I/We the undersigned, hereby apply to register/renew/transfer under the provisions of the Public Health & Wellbeing Act 2008 the Premises described hereunder to ALPINE RESORTS VICTORIA trading as FALLS CREEK ALPINE RESORT ('FCAR') for the year commencing 1 May 2018.

APPLICATION FOR *

REGISTRATIONRENEWAL OF REGISTRATIONTRANSFER OF HEALTH PREMISESONE OFF-ONGOING REGISTRATION

Applicant Details

First Name *

Last Name

ABN/ACN *

Postal address of applicant *

Contact numbers

Business phone *

Facsimile

Home phone

Mobile

Email Address *

Health Premises Details

Please choose the business activities that your business conducts *

Mobile HairdresserTattooingHairdresser/Make upColonic irrigationSkin Penetration PremisesBeauty Parlor & Similar EstablishmentOther

Please specify

BUSINESS OR TRADING NAME *

COMPANY NAME(if applicable)

ACN *

ADDRESS OF PREMISES *

PHONE NO *

FAX NO

Signature of Applicant(s) *

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Date

Privacy Statement

This information is collected under the requirements of the Public Health & Wellbeing Act 2008 for enforcement and Public Health purposes. It may be provided to the Department of Human Services for the same purposes, and for statistical purposes related to the application of the Act. It will be treated in compliance with the Department of Human Services Information Privacy Principles and the Information Privacy Act.

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