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2. Contact Information
4. Host Organization or Event Sponsor*
5. Is this organization a non-profit?*
   -- Select One --YesNo
7. Event Contact Person*
8. Title*

   i.e., event chair, board member, etc.

10. Host Organization's Complete Address*
12. Email Address*
13. Phone*
17. Event Details
19. Event Name*
20. Event Type*

    i.e., race, parade, market, block party, etc.

22. Event website

    If available, please provide a website with event details.

24. Event Location*
25. Event Date*
    Event Date
27. Set-Up Time*
    Set-Up Time
28. Start Time*
    Start Time
29. End Time*
    End Time
30. Breakdown Time*
    Breakdown Time
32. Anticipated Attendance (per day)*
33. Anticipated Staff (per day)*
35. If this is a recurring event, list additional dates.
37. Name and phone number for person(s) responsible for event clean up.*
41. Event Information
43. Will food be sold at the event?*
    -- Select One --YesNo
45. Will you cook food in the event area?*
    -- Select One --YesNo
46. If yes, specify the method (gas, electric, charcoal, etc.)
48. Will alcohol be served at the event?*
    -- Select One --YesNo
49. If yes, check all that apply.

    1. Free/Host Alcohol
    2. Alcohol Sales

    1. Beer
    2. Wine
51. If yes, describe your plan to ensure the safe sale or distribution of alcohol.
53. Will this event include the use of signs/banners?*
    -- Select One --YesNo
55. If yes, indicate the type and placement of signs.
57. Will road or streets need to be closed?*
    -- Select One --YesNo
59. If yes, specify the streets and cross streets.
61. Will "No Parking" signs be required?*
    -- Select One --YesNo
62. Estimate how many "No Parking" signs you will require the Town to provide.
    -- Select One --Noneless than 50more than 50
64. If yes, specify the location.
66. Will any structures be erected?*
    -- Select One --YesNo

    i.e., tent, stage, platform, etc.

68. If yes, specify the type and location.
70. Will pavement markings or route guides be placed on streets, sidewalks, or pathways?*
    -- Select One --YesNo
72. Will there be music at the event?*
    -- Select One --YesNo
73. If yes, specify the type.

    i.e., live band, recorded, etc.

75. Will there be amusement rides?*
    -- Select One --YesNo
76. If yes, specify the amusement ride company and provide their insurance information.
78. Will there be fireworks at the event?*
    -- Select One --YesNo
80. Is electricity needed?*
    -- Select One --YesNo
82. How many street barricades will you require the Town to provide?
84. How many traffic cones will you require the Town to provide?
86. Do you want police officers assigned to this event?*
    -- Select One --YesNoUnsure
88. Do you want EMT/firefighters assigned to this event?*
    -- Select One --YesNoUnsure
90. Do you want any life support equipment on-site for your event?*
    -- Select One --YesNoUnsure

    i.e., ambulances, fire trucks

92. Include any additional information about the event you'd like to share.
96. Insurance Information
98. List the insurance host organization or event sponsors insurance company, agent, and contact information.*
102. Certification and Signature
104. I understand and agree on behalf of the sponsoring organization that:
106. 1. A Certificate of Insurance must be provided which names the Town of Zionsville as an additional insured party on the policy (refer to Special Event Policy for insurance requirements).
108. 2. Event sponsors will be required to sign an Indemnification agreement.
110. 3. The approval of this Special Event Permit Application may include additional requirements and/or limitations, based on the Town's review of the application in accordance with the Town's Special Event Policy. The event will be operated in conformance with the Written Confirmation of Approval.
112. 4. The Event Sponsor will pay the $100 Special Event Permit Application Fee as required by the Town and will pay any invoice for Town Services which may be rendered.
114. By checking below, I agree to the terms and conditions.*

     1. I agree
118. Indemnification Agreement
120. Event Sponsor agrees unconditionally, absolutely, and irrevocably to defend, protect, and indemnify and hold harmless the Town of Zionsville, Indiana and its officers, agents, servants, and employees, from any claim, demand, suit, loss, cost or expense or any damage which may be asserted, claimed or recovered, against the Town of Zionsville, Indiana, by reason of any damage to property, personal injury, including death, sustained or claimed by any person or entity and which damage, injury or death arises out of or is in any way connected with the Event, and regardless of whether the damage, injury, or death is caused in whole or in part by the Event Sponsor, or by its officers, agents, servants, employees, vendors, subcontractors, or volunteers or by event participants or attendees.
122. By checking below, I agree to the indemnification agreement.*

     1. I agree
126. Attachments
128. Event Map

     Attach a route map if this event is a run or walk.

130. Site Plan

     Include a proposed site plan detailing your event. Include details such as barricade/cone placements, food/beverage vendors, water or electricity usage, portable restrooms, stages, tents, 

132. Certificate of Insurance

     Event sponsors or host organizations must provide a Certificate of Insurance naming the Town of Zionsville as an additional insured party on the policy. The COI must be submitted before the special event permit will be released. 

136. Special Event Permit Application Fee
138. You will receive an invoice for the $100 Special Event Permit Application fee on the following business day via email. Payment of this $100 fee is expected prior to staff review.
Leave This Blank:


140. 1. Receive an email copy of this form.
141. Email address

     This field is not part of the form submission.

142. Submit

* indicates a required field