Block Party Request Form

TYPE OF EVENT * Required
- Block Party
- Other
LOCATION OF EVENT * Required
Street Name
Between * Required
Street Name & Street Name
Date * Required
MM slash DD slash YYYY
Time * Required

: Hours

Minutes

AM/PM AM/PM
Rain Date
Agreement: * Required
- Agree, The Applicant agrees to abide by all applicable City Ordinances and regulations set forth on page 2 of this permit, to assume responsibility for the placement and safegurading of barricades, signs, etc. loaned buy the City, and to clean up the street after the event. The applicant further agrees to idemnify and hold harmless the City, its agents and employees, from and against and employees, from and against any and all claims, demand, lawsuit or judgement made by any person, arising out of any exercises of privilege granted by this permit and to reimburse the City for any expense incurred by it by reason of any such claim, demand, lawsuit or judgement.
Name * Required
First Last
Address * Required
Street Address Address Line 2 City State ZIP Code
Phone * Required
Email * Required
Deliver Barricades & Signs To:
Name and address if different from Applicant. Signs and barricades notifying vehicle operators of the street closing must be installed by the applicant. These will be delivered the Friday prior to the event and picked up the Monday afterwords. One (1) "BLOCK PARTY ROAD CLOSED" sign on a barricade to be placed at each end of the block.
Police and Fire Department Personnel
- Yes, I would like a representative from the Police and Fire Depatments to stop by if available
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