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2. Organization/Organizer Information:
4. Organization Name*
6. Organization's Address*
8. City*
9. State*
10. Zip Code*
12. Point of Contact's Name*
13. Point of Contact's Email Address*
15. Point of Contact's Phone Number*

    By submitting your phone number you are giving your permission to receive phone calls by Public Safety personnel to discuss details of this submission.

16. Additional Contact Information

    Please indicate any additional Organization/Event Contact information here. Please use the format (NAME (first & last), XXX-XXX-XXXX)

20. Event Information:
22. Event Name*
23. Event Venue (Event Location)*

    Please indicate where the Event is scheduled to be held. (Ex: Medfield State Hospital)

25. Address*
26. Event Date and Time*
    Event Date and Time Start Date

    Event Date and Time Start Time

    —

    Event Date and Time End Date

    Event Date and Time End Time
28. Number of Expected Guests*

    1. 0-50
    2. 51-100
    3. 100-500
    4. 500 or more

    Please select the corresponding number of guests projected for your event.

29. Rain Date and Time
    Rain Date and Time Start Date

    Rain Date and Time Start Time

    —

    Rain Date and Time End Date

    Rain Date and Time End Time

    Please indicate (if applicable) a rain date if for an unforeseen circumstance the event needs to be cancelled. 

31. Event Theme
32. Key Messaging/Advertising

    Please indicate how the event is being advertised.

34. Event Goals
36. Event Summary*
38. Ticketed Event*

    1. Yes
    2. No
    3. Unsure

    Please indicate if this is a ticketed event.

42. Event Needs:
44. Anticipated Police/Fire/EMS/DPW Needs*

    Please indicate any anticipated needs for any Public Safety Needs. Costs for details will be provided prior to event.

45. Anticipated Road Closures?*

    Please indicate if any roads are requested to be closed. 

47. Organization Provided Resources*

    What resources will the organization/organizer be providing for the event?

49. Special Licensing and Permiting*

    1. Yes
    2. No

    Has the organizer/organization applied for and received all Municipal Permits through appropriate town departments?

51. Handicapped Accessibility Needs:*

    1. Yes
    2. No
    3. Unsure

    Are handicapped accessibility needs being requested for this event?

52. If yes, please indicate what needs are being requested.*

    If no, indicate "N/A' in this field.

54. Will Tents/Barricades be used for this event*

    1. Yes
    2. No
    3. Unsure
55. If yes, please indicate company name, contact information and dimensions of the tents*

    If no, indicate "N/A' in this field.

57. Will security personnel be used*

    1. Yes
    2. No
58. If yes, please indicate security company name, contact information and how many officers*

    If no, indicate "N/A" in this field.

60. Will food services be used for this event*

    1. Yes
    2. No
    3. Unsure
61. If yes, please indicate company name and contact information*

    If no, indicate "N/A" in this field.

63. Trash Removal*

    The event organizer will be responsible for removal of ALL trash. Please identify how recycled items will be collected and disposed of.

67. Event Submissions:
69. Please provide site or route information for any parades/road races, etc.*

    If none, indicate "N/A" in this field.

71. Event Documentation

    Please upload any related documents for this event (i.e. advertisements, route information, plans, etc.)

75. Form Submission:
77. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree that all the information above has been completed to the best of your knowledge and that you have provided all required information in order to determine public safety needs. 

    By checking the "I agree" box below, you agree that this submission is merely a request and NOT granting permission for the event.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
79. Electronic Signature
80. Date*
    Date
Leave This Blank:


82. 1. Receive an email copy of this form.
83. Email address

    This field is not part of the form submission.

84. Submit Submit and Print

* indicates a required field