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2. Application Date & Time: *
   Application Date & Time:

   Application Date & Time:
4. Organization Name*
5. Event Title*
7. Contact Name*
8. Address*
10. City*
11. State*
12. Zip Code*
14. Work Phone*
15. Mobile Phone*
17. Email Address*
18. Requested Date of Event*
20. Requested Time Frame:
22. Set-Up:*

    (Set-up time must take place no earlier than 7 AM)

23. Registration:*
24. Event Start Time:*
25. Vacate Time: 1:00 PM
27. Anticipated # of participants/attendees:*
28. Anticipated # of volunteers you will provide:*
30. Intended Walk/Run distance, if applicable:*
32. Desired use areas (please include indoor facilities, outdoor space and trail areas (route) that you are requesting*
34. Do you have a 501 c3 Non-Profit Status *

    1. Yes
    2. No
35. Do you have liability insurance?*

    1. Yes
    2. No
37. Will you need access to water?

    1. Yes
    2. No
38. If Yes, what for?*
40. Will you rent a large tent or canopy?*

    1. Yes
    2. No

    *All tents must be weighted ONLY, not staked, and approved by the Parks Department

41. How many tents?
43. Is your event open to the public?*

    1. Yes
    2. No
44. Are you advertising the event to the public?*

    1. Yes
    2. No
46. Will you charge an entry fee?*

    1. Yes
    2. No
47. If Yes, how much?
49. Will you charge a registration fee?

    1. Yes
    2. No
50. If Yes, how much?
52. Will you need access to outdoor electrical?*

    1. Yes
    2. No
53. Will you serve alcohol?*

    1. Yes
    2. No
55. Will you sell alcohol?*

    1. Yes
    2. No
56. Will attendees bring their own alcohol?*

    1. Yes
    2. No
58. Will you serve food?*

    1. Yes
    2. No
59. Will you sell food?*

    1. Yes
    2. No
61. Will you prepare food on site?*

    1. Yes
    2. No

    *If Yes, food preparation and or sales must be pre-approved by the Kalamazoo County Health Department (269) 373-5351. Proof of proper licensing is required to be submitted to the Parks Department to ensure event can proceed. 

62. Will food be prepared at home?*

    1. Yes
    2. No
64. Will licensed vendors sell food?*

    1. Yes
    2. No
65. If Yes, who?
67. Will licensed vendors prepare food?*

    1. Yes
    2. No
68. Will licensed vendors be selling merchandise?*

    1. Yes
    2. No
70. Are you able to provide volunteers for parking/etc.?*

    1. Yes
    2. No

    *If required, a minimum of 2 volunteers per parking lot.

72. Please give a brief description of your event*
76. For Portage Parks and Recreation Staff ONLY
78. Electronic Walk/Run Manager Signature
79. Date:
    Date:
81. Electronic Parks Director Signature
82. Date:
    Date:
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit Submit and Print

* indicates a required field