2. If you wish to have a block party, please complete the following request form.   Block party requests must be made at least 10 days prior to the event.

   
   

   We will send you a confirmation letter via e-mail after we have reviewed and approved your party request. The approval process typically takes 3-5 days.

3. 

5. Block Party Representative Information:

7. Name of Applicant:*
9. Address:*
11. Cell Phone Number:*

    For Use on Day of Event

12. Home Phone Number:
14. Email Address:*

16. Block Party Details:

18. Event Date:
    Event Date:

    Saturday & Sunday Only

19. Starting Time:
    Starting Time:

    No earlier than 12pm

20. Ending Time:
    Ending Time:

    No later than 11pm

22. Rain Date:
    Rain Date:

    Saturday & Sunday Only

23. Starting Time:
    Starting Time:

    No earlier than 12pm

24. Ending Time:
    Ending Time:

    No later than 11pm

26. Have all residences been notified and invited to the block party?*

    1. Yes
    2. No
27. Are at least 50% of the residences in support of the block party?*

    1. Yes
    2. No
29. Activities Planned for Event:*

    Please indicate if you intend to have any of the following present at the block party:

    1. Bounce House
    2. Waterslide
    3. Other Novelties

    1. DJ
    2. Band
    3. None of the above
30. Please specify other novelties:

32. Village Services Requested:

34. Visit Requested from:
    -- Select One --Fire DepartmentPolice DepartmentPolice K9 Officer & DogVisits from all Departments
35. Time Requested:*
    Time Requested: Start Time

    —

    Time Requested: End Time

37. Assumption of Liability and Indemnification:

    
    

    The block party representative agrees to assume full responsibility for compliance with all conditions, fees or any costs associated with damage to Village property, clean-up by village crews or any other village expense incurred due to this event.

    The block party participants shall be strictly liable for the acts of its agents, volunteers, officers, employees and families and shall indemnify and hold harmless the Village of North Riverside, its officers, agents and employees from any claim, suit or liability whatsoever including, but not limited to, any court costs or reasonable attorney fees arising out of or in any way connected with any acts or omissions of the block party participants, its agents, volunteers, officers, employees and family.

39. Acknowledgement & Signature*

    I agree to comply with all provisions of the Village's general block party guidelines and policies.  Failure to comply with the requirements and conditions set forth by the Village will void the block party approval and allow the Village to shut down the block party.

    1. I agree.
41. Signature of Block Party Representative*
42. Date*
    Date
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field