HomeMy WebLinkAboutClaysburg Days (BPW approved 5/17/23).
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s,,1: � SPECIAL EVENT APPLICATIO
Submittal of this application does not guarantee approval of the event.
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This application must be completed in its entirety.Any applications not completed will be denied automatically. Before
applying, please acknowledge that addendum will be utilized in instances where additional liability on behalf of the
applicant may occur.Applications must include a detailed site plan which clearly shows all temporary structures including
but not limited to tents, portable toilets, stages. bleachers, dumpsters, fencing, inflatables, etc. at the time of
submission. If you are applying on behalf of a nonprofit, please provide proof of organization's nonprofit designation.
EVENT INFORMATION
Name of Event: CLAYSBURG DAYS
Type of Event: Park Festival
Event Date(s): Event Time: --1 Aug '23 (=RtDgy
Event Day 2: Event Time: Augb- '23
Event Day 3: Event Time:(a Aug '23
Event Location: Henry Lansden Park
Alternate Date, Time and Location none
Will additional time be needed for set up/break down? (please check)NO
Set up will begin on (date): at(time): /-{Aug ;23 1700hrs '
Break down will begin on (date): at(time): 6 Aug '23 1700hrs
Please provide a detailed description of your proposed event(be specific): Claysburg Days is an annual event held in Henry
Lansden Park, 15th St, Jeffersonville, IN. beginning on
Friday evening (Kid'S Day)-recently released box office movie to be displayed on 30ft projection screen. Refreshments
and gifts from local donators provided FREE for attending children under age of 14.
'Rain back up to be held at Envision Center* - 1 f- AO/La-it:
Saturday-all day MAIN REUNION EVENT-Event will officially begin at noon, however 14 and under basketball camp to
begin at 10am in the Envision Center. All other events will take place inside and the immediate surrounding area of the
park. Events will include: live bands, DJ,African dance step show, playing card (Spades, Bid Wiz, Uno tournaments),
cornhole tournament. Lots of vendors and family friendly activities.
Is this event open to the public? (please check)YES
Estimated attendance*: 1000-2000
Estimated number of teams participating? (athletic tournament only) unknown
"Fees may be assessed during post event inspection if actual attendance exceeds above estimate
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ORGANIZATION INFORMATION
Organization producing the event: (please check)
For Neighborhood Association
Other:
Name: Claysburg Heritage Reunion Committee
Street Address: 1726 Elmwood Dr. Clarksville IN.47129
City: State: Zip Code: WebsiteLPhone: Email:
Social Media;
On-site Contact Name.. LaToya Torrence
On-site Contact Phone: 5028550372
On-site Contact EmailL LTorrence84@gmail.com
Phone number and/or email you want the public to contact for more information and to be listed online:
Number of years this event has taken place in Jeffersonville: 25
Is this event produced in other NO
Adults Children Seniors How will ticket sale revenue be used?All hosted events will be
FREE
If the proceeds of the event are intended for an organization other than the applicant, please provide the following
information: Benefit Organization:
°A)of funds which will be donated:
Contact Person:
Contact Phone:
Terms of the agreement:
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ROAD CLOSURE
Will your event require road closures? NO
If yes, please describe the roads that would be closed and provide the opening/closing dates and times.Also, please
attach map detailing closures and cross streets.
Name of streets:
Date/lime of Closure:
Date/Time of Opening:
PARKING
Will you need any parking lots reserved for non-public use? (please check)YES
Will you be using areas for off-site parking?(please check) NO
TRAFFIC CONTROL
Will your event require traffic control?(please check) NO
ALCOHOL
Will alcohol be served at your event?(please check) NO
FOOD
Will food be served at your event?(please check)NO
If yes,will food be self-prepared?(please check)NO
INFLATABLE ATTRACTIONS:
(Please make sure to include on site map)
Will inflatable attractions(bounce houses, slides, games)be part of this event?(please check)YES If yes,who will
staff the attractions?Vendor Event Staff
AMPLIFIED SOUND:
Will amplified sound be used at your event? (please check)YES
If yes,what will be amplified (both music, speeches, etc.)?(please check)YES
If yes,what time(s)will sound be amplified? 12-10p
If yes,what sound company will provide sound? unknown
AUDIONISUAL EQUIPMENT:
Please list any NV equipment to be used at your event: speakers, amplifier 30ft inflated projection screen.
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FENCING
(Please make sure to include on site map)
Will you be using temporary fencing for your event?(please check) NO If yes,what
company will provide fencing?
REFUSE AND RECYCLING
(Please make sure to include on site map)
Will you need refuse containers(dumpsters)for your event?(please check)YES If yes, how
many will be used? 1 large dumpster and approximately 20-25 cans.
If yes,what company will provide refuse and recycling services?
RESTROOMS
(Please make sure to include on site map)
Will your event require temporary restrooms?(please check)YES If yes, how many? If yes,what
company will provide restroom services?
CLEAN-UP:
Will you use a cleaning company for event clean-up?(please check)YES If yes,what
company will provide cleaning service?
ELECTRICITY:
Will you be using temporary electric(generator)at your event? (please check)YES If yes,what
company will provide electric service? Vendor private use
TENTS
(Please make sure to include on site map)
Will you be using tents, stages, ticket booths, etc. at the event?(please check)YES If yes,will tents be
larger than 150 square feet(larger tents require permit)?(please check)NO If yes, please indicate the
number and size of tents and desribe how tents will be used:
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If yes for larger tents,what company will be providing tents?
PROMOTING/ADVERTISING:
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What type of promotion/advertising do you have planned for your event?social Media, local news sources, radio
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SIGN AND RETURN this completed application with supporting documents to the Jeffersonville Parks
Department,Attn: City Events Planning Board.
Email: parksinfo(@citvofieff.net Mail: 500 Quartermaster Court Jeffersonville, IN 47130
Applicant agrees that the contents of the application are complete, true and accurate to the best of their knowledge,
information and belief, and agrees to ensure compliance with the policies set by the City Events Planning Board.
Signature of Applicant Date LaToya Torrence,4 February '23
*Upon approval by the City Events Planning Board, applicant will be required to pay the Special Event Permit Fee
determined by the Board. This fee is usually set at$150 per application, but may be increased depending on use of
city services, risk assessment or other factors.
**A certificate of insurance is required for all events, with minimum coverage of $1,000,000 liability. The certificate
must list the City of Jeffersonville as additional insured, and must be submitted to the Parks Department at least 10
days prior to the event date.
This section to be completed by City Events Planning Board
PERMIT FEE I'CO,`"
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