Provide details about the sports ground

Name of sports ground

Club or organisation that operates the sports ground

Address of sports ground

PRINCIPLE CONTACT AT SPORTS GROUND

Provide details about the principle contact at the sports ground

Name

Address for correspondence (if different from Sports Ground Address above)

Contact details

Email address

Main telephone number

Other telephone number

Fax number

Qualified Person

Email Address

Nomination of qualified person

State how the decision was made to nominate this person

Was this decision included in the minutes of a Committee or Board Meeting?

Yes No

If yes, a copy of the minutes should be included with this application

State how the decision was conveyed to the nominated person

Has the nominated person accepted the role?

Yes No

Indicate whether your application is for:

A sports ground with a capacity of 5,000 + spectators (Designated Sports Ground)

A stand which provides covered accommodation for 500 + spectators (Regulated Stand)

Name and location of the regulated stand for which the application is being made:

Type of safety certificate

Indicate which type of safety certificate you require:

General safety certificate  – Covers activities over an indefinite period

Provide a list of all the sports to be played at the sports ground and to be included in the General Safety Certificate

Special safety certificate  – covers one occasion or a series of occasions

Event or activity for which the special safety certificate is required (e.g. pop concert, display, festival, dog show)

You can only apply for a Special Safety Certificate if you already have a General Safety Certificate

Give the date(s) of the proposed event with start and finish times

ADDITIONAL DETAILS