HomeMy WebLinkAbout4.23 Earth Day - Mind, Body, Spirit Festival Application1
Bridget Fields
From:SBVPA Website Form <noreply@sbvpa.org>
Sent:Thursday, January 6, 2022 6:03 PM
To:Bridget Fields
Subject:South Bend Park Rental Form
Section 1: Applicant Information
Applicant Name
Jamila Blue
Applicant Phone
5747422174
E-Mail
jamila@consciousmichiana.com
Address
1302 High St
Organization Name
Conscious Michiana Inc.
Section 2: Event Information
Event Name
Earth Day - Mind/Body/Spirit Festival
Is this a return event?
No
Type of Event
Public (Open for Public/Anyone can Attend)
Type of Event
Large Festival/Fair
Name of Park Requesting
Potawatomi Park
Specific Site in Park
band shelter area
Event Date Requesting
4/23/2022
Anticipated Attendance Range
500-1,000
Event Start Time
2
10:00 am
Event End Time
06:00 pm
Set-Up Date
04/23/2022
Set-Up Time
08:00 am
Tear-Down Date
04/23/2022
Tear-Down Time
06:00 pm
Is this event ticketed?
No
If yes, how much are tickets?
0
How can the public purchase tickets?
Before the event only
Is the applicant working on behalf of another organization?
No
Will the event require use of electric?
Yes
Will the event require use of water?
Yes
Brief Description of Event
Celebrate Earth Day with our Mind - Body - Spirit festival. Enjoy live music, food, art, and an all day celebration of health and
wellness from a variety of our local practitioners. There will be free classes and events for all ages throughout the day, such as
yoga, qigong, sound healing and more.
Section 3: Event Logistics
Will an outside company or caterer be preparing and/or serving food in the park for this event?
Yes
Will there be beer and/or wine served at the event?
No
Will a company be providing any entertainment, equipment, portable restrooms, AV, stages, tents, or inflatables?
Yes
Section 4: Public Works
Will the event require the closure of any streets or use and public sidewalks?
No, the event will be entirely contained within the park (If no, continue to Section 5)
3
Section 5: Insurance
Is the event interested in purchasing insurance through the City of South Bend?
Yes, the event would like to learn more about purchasing insurance through the City of South Bend
Section 7: Indemnity & Hold Harmless Agreement
Waiver
To help protect your privacy, Microsoft Office prevented automatic download of this picture from the Internet.I agree to the waiver.
I (authorized organizer) will release and discharge the City of South Bend and the Board of Park Commissioners, Parks
Department, and all organization volunteers from any and all liabilities due to any damage, injury, or loss of property.
I agree to this written contract and will abide by the rules set forth.
Section 8: Regulations & Agreement
Date
01/06/2022
Name
Jamila Blue
Agreement
To help protect your privacy, Microsoft Office prevented automatic download of this picture from the Internet.I agree to follow the procedure listed above.
Form submission from the sbvpa.org website.