Application
CONTACT INFORMATION
| Event/Activity Name |
---
|
| Facility (See link to park locations and descriptions above) |
---
|
| ***Other Description |
Mary O'Malley State Park
|
| Event Date |
07/30/2022
|
| Applicants Name |
---
|
| Contact Person |
---
|
| Email Address |
---
|
| Cell Phone |
---
|
| Day Phone |
---
|
| Billing Address |
---
|
EVENT INFORMATION
| Name of Supervisor / Vendor on Site |
---
|
| Supervisor / Vendor Phone Number |
+19783769474
|
| Name of Second Supervisor on Site |
---
|
| Second Supervisor Phone Number |
+19783769474
|
| Total Estimated Number of Participants |
40
|
| Estimated Number of ADULT Participants |
20
|
| Estimated Number of YOUTH Participants |
20
|
| Activity |
Other (please specify below)
|
| Brief Description of Event |
---
|
First Preference For Event Date
| Is this event happening on one date or multiple dates? |
---
|
First preference: Single Date - Time
| Date |
2022-07-30
|
| Total Time (ex. 2:00pm-6:00pm) |
---
|
| Set-up Time (ex. 2:00pm-3:00pm) |
---
|
| Total Event Time (ex. 3:00pm-5:30pm) |
---
|
| Breakdown Time (ex. 5:30pm-6:00pm) |
5-30-6pm
|
Second Choice - Single Date
| If your first choice date is not available, do you have a second choice? |
---
|
Specialized Event
| Does your event fall under one of these categories? |
No
|
Licensing Department and Inspectional Services Department
| Are any of the following part of your event? |
Food and beverages , Music, entertainment, or amplified sound on site
|
Food and Beverage/ Fire Department and Licensing
| Please specify all food and beverages that will be provided |
---
|
Music and Entertainment: One Day Entertainment License Requirement
| Please describe the type of music or entertainment to be provided: |
Kids birthday music
|
Department of Public Works
| Will you require lighting? (Please call 617-466-4200 during business hours, and 617-828-7327 after hours).) |
---
|
| Will you require use of restrooms, if available? |
---
|
Indemnification / hold harmless / cleanup
Indemnification/Hold harmless/cleanup
| The signatory shall be responsible for and shall indemnify and hold harmless the City of Chelsea from and against all damages, claims or demands that may, during the term of this license, arise by negligent or intentional acts of signatory or signatory's employees. |
I am responsible for any and all indemnity and hold harmless the City of Chelsea
|
| If a permit is issued, I agree that my organization will leave the permitted area clean and orderly, and that all trash will be placed in trash receptacles. |
I agree to pick up and clean any trash caused by this event
|
| I understand that I am completing a binding electronic signature when I submit this form constitutes a legal signature. |
Yes
|
| Up Load Insurance policy/agreement |
|
