Special Event Organizer Application Form

Event Name:

Event Date:

Event Location:

Venue Type:

Public Park

Street Festival

Community Centre

Other

Other, please specify:

Event Duration:

1 Day

2-3 Days

4-7 Days

Total Attendance:

Under 800

Over 800

Annual Event?

Yes

No

Organizer/Contact Information

Organizer/Contact Person:

Address:

City/Town:

Postal Code:

Home Phone:

Business Phone:

Cellphone:

Email Address:

Website:

Vendor Information

Are food vendors participating?

Yes

No

If yes, vendor names and phone numbers:

Personal Service Setting Booth(s) (piercing, tattoo, manicure, etc)?

Yes

No

If yes, vendor names and phone numbers:

Will any Vendors have a petting zoo or animal exhibit?

Yes

No

If yes, vendor names and phone numbers:

Total Number of Vendors Patricipating:

The information on this form is collected under the authority of the Health Protection and Promotion Act in accordance with the Municipal Freedom of Information and Protection of Privacy Act and the Personal Health Information Protection Act. This information will be used for the delivery of public health programs and services; the administration of the agency; and the maintenance of healthcare databases, registries and related research, in compliance with legal and regulatory requirements. Any questions about the collection of this information should be addressed to Client and Community Support at 1-800-265-7293 ext. 7006 or clientcommunitysupport@wdgpublichealth.ca.

Special Event Organizer Application Form

Water Supply

Hydro

Sanitary Facilities

Garbage

Special Event Organizer Application Form

Water Supply

Hydro

Sanitary Facilities

Garbage

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