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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 - Thomas Hayes
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. Block Party Starting Point*
25. Block Party Ending Point*
27. Street Closure Location Starting Point:*
29. Street Closure Location Ending Point*
31. Barricade Drop Off / Pick Up Location*
33. 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.
35. Will there be tent(s)?*

    If yes, please indicate the size of each tent. 

36. Will there be stage(s)*

    If yes, please indicate size and height of each stage. 

38. Site Plan*

    Please provide a drawing/layout of event, we recommend area view in Google Maps. 
    Applications will not be considered without this item.
    Must include but not limited to: street names, chairs, tables, tents, stage, barricades, garbage etc.

    the location, direction, and size of all loudspeakers and amplified sound systems;

    the proposed location of all controlled entrances and exits from the event premises;

    an emergency evacuation plan; and

    the location and number of portable toilets, hand washing stations and permanent bathrooms

    Applications will not be considered without this item.

40. Noise Ordinance Acknowledgement and Acceptance*

    1. I agree

    Must adhere to City’s noise ordinance.  Chapter 11, Article II. Noise Control

42. 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.

44. Acknowledgement and Acceptance*

    1. I agree.

    I certify that ALL residents on the block have been notified of the event and street closure.
46. Block Party Electronic Signature*

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

47. Date Signed*
    Date Signed
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit Submit and Print

* indicates a required field