Special Event Permit Application

Special Use Permit Application

Rockford Park District
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name / Organization:
Contact Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email
example@example.com
Event Name:
Event Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Event Hours:
Event Hours:

Hour Minutes

AM/PM Option

Until

Hour Minutes

AM/PM Option
Does your event include the use of a Rockford Park District shelter?
Park / Facility Name:
Park / Facility Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated Attendance:
Is this function open to the public?
Will fees be charged?
Amount to be charged?
Will sales be made?
What items will be sold?
Will collections be taken?
Purpose of collection?
Description of activities:
Additional information / Notes:
Should be Empty: