Fillable Special Event Information Form printable pdf download

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SPECIAL EVENT

INFORMATION FORM

It is the event sponsor/organizer’s responsibility to obtain necessary barricades, signs and/or

cones for the event.

Other agency permits may be required at the responsibility of the applicant.

APPLICANT INFORMATION:

Name: ______________________________

Phone: _______________

Fax: ____________________

Street Address: ___________________________________

E-Mail: ______________________________

City: ________________________________________

State: __________

Zip: ___________________

EVENT INFORMATION:

Description of Event: ______________________________________________________________________

Event Date(s) ________________________________ Day(s) of week: _______________________________

Start Time: __________End Time: __________ Approx. Number of Participants: ______________________

Location of Closure (Attach Map):____________________________________________________________

EVENT SPONSOR/ORGANIZATION: ______________________________________________________

Contact Person: _____________________________________E-mail: ________________________________

Phone: Cell _______________________ Work ______________________ Home ______________________

Acknowledgement of Responsibility by Applicant/ Sponsor

I recognize that applicants for a special events permit bear full responsibility for the orderly conduct of the

special event permitted hereby and that the City of Post Falls provides no guarantee of safety or success. I

hereby certify that as sponsor of the event I (we) will endeavor to assure that all participants will comply with

the laws, regulations, and the event requirements established by the City of Post Falls regarding such event.

Furthermore, I hereby indemnify and hold the City of Post Falls harmless from any and all claims associated

with this event.

Applicant Signature: __________________________________________ Date: ________________________

This information form is processed for information only by the Community Development Department.

Date: _________________________ Distribution to the following city departments for their information:

►City Administrator ►Police Dept ►Parks Dept ►Street Dept ►Engineering Dept

Distributed to the following public agencies for their information:

►Fire District ►Sheriff Department

If there is department or agency concerns, the department or agency must contact the applicant directly.

Community Development Department

408 N. Spokane St. Post Falls, ID 83854

(T): 208-773-8708

(F): 208-773-2505

Web:

Special Event Information Form