Author: B Hunter

Date of Event:
Name of Event:
Applicant Organization:

SPECIAL EVENT APPLICATION APPROVAL

Contact Information
Contact Person:			Daytime Phone:
Mailing Address:			Home Phone:
			Cellular Phone:
			E-mail:
Postal Code:

On-site Contact:			Daytime Phone:
Mailing Address:			Home Phone:
			Cellular Phone:
			E-mail:
Postal Code:

Event Details
Event Description:
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Describe the benefit of this event to the community:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Event Budget:			Please attach list of sponsors or potential sponsors

Event Location:					Set up time:
Has event occurred before:					Event Start Time:
If yes, date(s):					Event End Time:
# of Participants/Spectators:					Clean Up Time:

Yes

No

Will your event require any of the following:
Street Closures:		If yes, include information on Races, Parades, Roadways Map
Access to multiple municipal locations:		If yes, include information on Site Map
Parking:		If yes, include information on Site Map

Yes

No

Yes

No

Yes

No

Outline your plan for notifying businesses/residents who will be affected by this event and when this will be completed by: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Activities and Site Set Up
Will your event include any of the following:
Food/Vending:		Vendor:
Alcohol:		Liquor license? (Please attach):
Entertainment:		Source:
Tents/Inflatables/Temporary Structures:		List all (include quantity, size, ownership, location and type of anchorage):
Police Department:
Fire Department:
Medical Service:
Professional Security:		Company/Contact Information:

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

Yes

No

What Town resources do you require in order to hold your event?
Please be specific with these details, include numbers for items required, work required and any other information which may be relevant: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Additional Comments:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

o I/we uphold our obligations under the New Brunswick Human Rights Act and will continue to do so at all times while using town property pursuant to this agreement
o I/we undertake to be considerate of all other users of town property and respect their right to enjoy town facilities while this rental agreement is in place. If, in the town’s sole opinion, this right may be compromised OR if the safety or security of other users or town residents becomes at risk as a result of any of my/our activities the town shall have the right to immediately cancel this agreement on the advice of local law enforcement. My/our conduct during prior rentals of town or other property may be taken into consideration by the town in the foregoing assessment of risk.
o I/we agree that a cancellation of this agreement or our failure to comply with all terms of this agreement will constitute sufficient cause for the town to deny future rentals to me/us.
NOTICE
The town of Quispamsis does not, by virtue of entering into this agreement, in any way endorse the content of materials presented by organizations renting town property which are inconsistent with town policies, mission and vision statements and statements of guiding principles.
All events on the Town of Quispamsis property need to have Commercial Liability Insurance.
Insurance: ALL BOOKINGS MUST HAVE INSURANCE.
o I have insurance (if you carry Commercial General Liability Insurance, please provide a copy with the addition of the Town of Quispamsis as insured, you must have no less the $5 million per occurrence against all claims for bodily/personal injury including and resulting in death and property damage). - Proof of insurance is required no later than 2 weeks before booked date, insurance must remain in effect for the duration of the booking. o I would like to purchase insurance from the Town of Quispamsis (see Facility User Liability Insurance Coverage rate chart and other documents on our website. www.quispamsis.ca). - Purchase of the Facility User Liability Insurance coverage must be done at the time of booking if no other insurance is in place.
The Town of Quispamsis reserves the right to cancel this agreement or any reserved/booked times upon notification, or by reason beyond the control of the Town of Quispamsis, (weather, power outages, mechanical failure, emergency, or any other unforeseen conditions).
General insurance costs will be evaluated with information provided:

I, _______________________________ am the person authorized to execute documents on behalf of ____________________________________________ (the applicant organization).
The applicant organization does hereby agree to indemnify and save harmless the Town of Quispamsis in respect to any and all claims, demands, suits and costs arising out of any act or omission of the organizer or of any servant, agent or officer of the organizer arising out of or resulting from the use of the site/route by the organizer.
On behalf of the applicant organization, I acknowledge that I have read and understood the conditions contained in the Guidelines for Special Events Applications and agree to comply with them.

Signature:			Date:

Forms may be submitted by mail to:
Community Services
Administration Manager
Town of Quispamsis
12 Landing Court
Quispamsis, NB E2E 4R2
or by fax to: (506) 848-5910
or by e-mail to:
communityservice@quispamsis.ca
T: (506) 848-5900

Have you attached the following relevant documents to this application?:
List of Sponsors/Potential Sponsors
Races/Walk/Parade Route Map:
For parades, line-up with list of floats, walkers and vehicles:
Site Map of the event location:
Liquor License
Safety Plan
Copy of Insurance
List of event staff and volunteers:

Yes

No

NA

Yes

No

NA

Yes

No

NA

Yes

No

NA

Yes

No

NA

Yes

No

NA

Yes

No

NA

Yes

No

NA

Town of Quispamsis - Special Event Application #