HomeMy WebLinkAbout5.21 I Walk With Fosters Park Use Application1
Bridget Fields
From:SBVPA Website Form <noreply@sbvpa.org>
Sent:Monday, December 6, 2021 10:51 AM
To:Bridget Fields
Subject:South Bend Park Rental Form
Section 1: Applicant Information
Applicant Name
Alicia Kimble
Applicant Phone
5743445909
E-Mail
alicia.kimble@whitesrfs.org
Address
21571 West Ireland Road
Organization Name
Josiah White's Foster Care
Section 2: Event Information
Event Name
I Walk with Fosters
Is this a return event?
No
Type of Event
Private (Invite Only/Guest List)
Type of Event
Processional Event (Walk/Run)
Name of Park Requesting
Howard Park
Specific Site in Park
Field
Event Date Requesting
May 21, 2022
Anticipated Attendance Range
75-150
Event Start Time
2
10:00 am
Event End Time
05:00 pm
Set-Up Date
05/21/2022
Set-Up Time
07:00 am
Tear-Down Date
05/21/2022
Tear-Down Time
06:00 pm
Is this event ticketed?
Yes
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?
No
Brief Description of Event
I Walk with Foster's is a walk supporting children in the foster care system and those who foster. It will bring support and
awareness in the community as May is "National Foster Care Month."
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?
Yes, the event will need to close a street or use a public sidewalk
Section 5: Insurance
Is the event interested in purchasing insurance through the City of South Bend?
3
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
12/06/2021
Name
Alicia Kimble
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.