Purpose of RegistrationTo identify free food services operating within the Liverpool Local Government Area and keep an updated resource list of locations, operating hours and key contacts for those services. This will assist Council in identifying possible impacts future events may have on free food services in Liverpool.

Part 1: Service Provider DetailsName of Organisation:

Address of Organisation:

Contact for Organisation: Position:

Phone number: Mobile number: Email address:

Contact for food service: Position:

Phone number: Mobile number: Email address:

Part 2: Service DetailsPlease complete the Service Provision Details table over the page

Note: Please include your set up and pack up times and detail the type of service provided e.g. hot meals, blankets, coffee, tea, etc.

Part 3: Registration DeclarationI declare at the time of writing, the information provided in this registration is accurate. I commit to notify Liverpool City Council if the conditions/details provided on the form change so that Council can amend any applicable support services.

Name: Position: Signature: Date:

Part 4: Lodgement DetailsPlease lodge your completed registration form to:

Email: foodservices@liverpool.nsw.gov.au Fax: 9821 9333 Mail: Locked Bag 7064 Liverpool BC NSW 1871In person: Level 2, 33 Moore Street Liverpool

For further information please phone 9821 7785 or email Jamett-CaruP@liverpool.nsw.gov.au

REGISTRATION FORMFree Food Service

April 2015

Service Provision Details

LocationE.g. Pioneers’ Memorial Park, Liverpool

TimeE.g. 8.30pm – 10.30pm (please include set up and pack up times)

Service/s providedE.g. Hot meals, blankets, coffee/ tea

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday