Event name Date of event Start and end time Must be a minimum of four (4) hours. Event Location and Address Address City/Town Province Postal Code In which community is the event taking place? - None -Central SaanichColwoodEsquimaltHighlandsJuan de FucaLangfordMetchosinNorth SaanichOak BaySaanichSidneySookeVictoriaView Royal Will there be bottled water sales through concession or vendors? Yes No Is this event licensed for alcohol sales? Yes No Is there a cost for the CRD to participate in this event? Yes No What type of event is this? School Sports Community Music/festival Fundraiser Other Enter other… Permit information Has an event permit application been made? Yes Not required Not yet (request will be made) Do you have authorization to use an on-site potable water source (eg. tap, hose bibb)? Note: the CRD is not responsible for costs incurred. Water source must not come from irrigation. Yes No Not yet (request will be made) Is the event coordinator responsible for water approval? Yes NoLocation for the water stationsThe location of the water stations must be on level ground and within 10m of the potable water source connection. If distance is more than 10m to potable water source, additional water hoses can be connected. Does your location meet these criteria? Yes No Other (please explain) Enter other… Is there sufficient space for a CRD display to promote regional water conservation initiatives? Yes No Is the water station location accessible by vehicle? Yes No Will the stations be set up in one location at the event or at multiple locations on site? One location Mulitple locations Is there a designated space for placement of the outlet hose to drain excess water from the refill stations? Yes No If this is a multi-day event, will on-site security be provided?* Yes No This is not a multi-day event What surface will the water stations be located on? Sand Gravel Grass Pavement Other (please specify) Enter other… Contact information Primary contact name Primary Contact - First Name Primary Contact - Last Name Organization Phone Number Email Alternate contact name Alternate Contact - First Name Alternate Contact - Last Name Alternate contact phone number Alternate contact email Please include any additional comments belowPersonal information on this form is collected by the Capital Regional District (CRD) under Section 26 (c) of the Freedom of Information and Protection of Privacy Act and will be used to enable and support the water station booking process. Should you have questions about the collection of this information, please contact Jody Watson, Supervisor, Environmental Stewardship Initiatives, 625 Fisgard Street, Victoria BC, V8W 1R7, at 250.360.3307 or by email.