Form Center

Block Party Application

2. Requestor Name*

4. Requestor Address*

6. Requestor City*

7. Requestor State*

8. Requestor Zip*

10. Requestor Phone*

11. Requestor Email

13. Ward and Aldermen
    -- Select One --1st Ward - Dr. Sylvia Sims Bolton2nd Ward - Patrick D. Seger3rd Ward - Gregory D. Moisio4th Ward - Roudell Kirkwood5th Ward - Edith Newsome6th Ward - Keith E. Turner7th Ward - Felix Rivera8th Ward - Dr. Lynn M. Florian9th Ward - Ann Taylor

15. Event Date*
    Event Date

16. Event Start Time*
    Event Start Time

17. Event End Time*
    Event End Time

18. Expected Attendance*

20. Are you requesting a visit by Police?*

    1. Yes
    2. No

21. Are you requesting a visit by Fire?*

    1. Yes
    2. No

23. Street Closure Location:*

25. Barricade Drop Off / Pick Up Location*

27. Barricades*

    Barricades will be delivered the day before the event and picked up on the Monday following the event.

    1. I have read and understand.
29. Site Plan*

    Please provide a reproducible drawing/layout of event. If you need additional space, please attach a separate sheet. Applications will not be considered without this item.

31. COVID-19 Notice and Acceptance*

    1. I agree

    Local, County, State, and Federal Guidelines with respect to COVID-19, Coronavirus, will be adhered to. This includes, but is not limited to, social distancing, use of masks, hand washing, and use of hand sanitizer.

33. Acknowledgement and Acceptance*

    1. I agree.

    I certify that ALL residents on the block have been notified of the event and street closure.

35. Block Party Electronic Signature*

    By signing I confirm that I have read, understand and agree to the application requirements.

36. Date Signed*
    Date Signed

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field