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Special Event Application

Event Name *

Please describe the event with as much detail as possible.

Date of Application

Event Type *

Public Event Private Event

Start Date *

End Date *

For each day of the event, enter the Date of the Event, the Start Time, and the End Time. Use the Delete button (X) at the end of the row to delete any blank or unnecessary rows.

	Date of Event	Start Time	End Time
1	Date of Event *	Start Time *	End Time *

Date of Event

Start Time

End Time

Export Clear Add new row

Date of Event *

Start Time *

End Time *

Location/Address of Event *

City *

State *

ZIP Code *

In or Out of Town *

In Town Out of Town

Tax Parcel # (if applicable)

Is the Event Sponsor the Property owner where the event is being held? *

Yes No

Event Type (Check all that apply)

Community Day

Concert

Festival

Filming on Location

Parade

Run/Walk/5k

Swim/Boating

Other

Describe Other Event Type *

Expected Number of Attendees
*

Event Details (Check all that apply)

Admission Fee

Alcohol

Amplified Sound

Carnival Ride

Erected Seating

Fireworks

Heating Devices

Inflatables

Live Music

Marching Units

Motor Vehicles

Parking

Portable Toilets

Security

Signs & Banners

Special Effects

Temporary Outdoor Lighting

Tents/Shelters

Traffic Control

Vendors

Other

Describe Other Event Details *

Public Safety Services Needed (Check all that apply)

EMS - Paramedics

EOC - Dispatcher

EOC - Mobile Command Unit

Will the Delaware Office of Alcoholic Beverage Control be contacted? *

ABC Contact Information: 302.577.5222

Yes No

Will the Fire Marshal be contacted? *

Fire Marshal Contact Information: 302.856.5298

Yes No

Will the Delaware Division of Public Health be contacted? *

Delaware Division of Public Health Contact Information: 302.515.3300

Yes No

Will the Delaware State Police be contacted? *

DSP Contact Information: 302.672.5460 or DSPPayJobAdmin@CYAUSA.com

Yes No

Will the Delaware Department of Transportation be contacted? *

DelDOT Contact Information: 302.760.2080 or DOT_SpecialEvents@STATE.DE.US or http://eventpermits.deldot.gov

Yes No

Will the jurisdiction Fire and/or Ambulance Company be contacted? *

Yes No

Accepted File Formats: bmp, doc, docx, jpg, jpeg, pdf, png, xls, xlsx

Note: Multiple attachments are allowed. To add additional attachments, use the 'Add' button to add more Upload rows. Use the 'Remove' button to delete any unwanted Upload rows.

Attach File

Upload

Attachment Description

Applicant Information

Copy from Event Information

501(c)(3) Non Profit *

Yes No

Applicant Name *

Email Address *

Applicant Address *

City *

State *

ZIP Code *

Primary Phone Number *

Secondary Phone Number

Fax Number

Event Coordinator Information

Copy from Event Information

Copy from Applicant Information

Special Event ID

Event Coordinator Name *

Event Coordinator Email Address *

Event Coordinator Address *

City *

State *

ZIP Code *

Note: The following is the contact number of the person who will be available during the event.

Event Coordinator Phone Number *

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