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Block Party Application

2. Name

3. Email Address

5. Address

7. City

8. State

9. Zip Code

11. Phone Number

13. Event Date(s) & Time
    Event Date(s) & Time Start Date

    Event Date(s) & Time Start Time

    —

    Event Date(s) & Time End Date

    Event Date(s) & Time End Time

    Block parties must end (including cleanup and teardown) by 11 p.m.

15. Name of the street on which the party will occur

17. Additional Location Information (closest cross streets, cul-de-sac, etc.)

19. Would you like to reserve barricades?

    1. Yes
    2. No

21. Agreement
    By clicking “submit” the block party applicant waives and holds harmless the City of Portage, its officers, agents or representatives and employees, from and against any and all liability, actions, causes of actions, claims known and unknown now or in the future that may arise out of the hosting of a block party.

    By clicking “submit” the block party applicant waives and holds harmless the City of Portage, its officers, agents or representatives and employees, from and against any and all liability, actions, causes of actions, claims known and unknown now or in the future that may arise out of the hosting of a block party.

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field