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Alderman Ameya Pawar
47th Ward
2015 Block Party Request Form
Date Submitted__________________________
Requester’s Name______________________________________________________________________
Address______________________________________________________________________________
Telephone Number_____________________________________________________________________
Email Address_________________________________________________________________________
Alternate Contact (must have different address than above)__________________________________________
Address______________________________________________________________________________
Telephone Number_____________________________________________________________________
Email Address_________________________________________________________________________
Block Party Information
Date of Block Party (1st Choice)____________________________________________________________
2nd Choice (required)____________________________________________________________________
Start Time____________________________________________________________________________
End Time (no later than 10pm)____________________________________________________________
Street to be closed______________________________________________________________________
From* (ie: 2900)________________________________________________________________________
To* (ie: 2960)____________________________________________________________________
Comments or special instructions___________________________________________________
*Access to alleys must be kept open during the block party.
4243 N. Lincoln Ave. I Chicago, IL 60618 I Phone: 773-868-4747 I Fax: 773-549-4757
[email protected] I www.chicago47.org
CHICAGO FIRE DEPARTMENT
Special Events
3510 S. Michigan Ave 2nd FL
Chicago, IL 60653
Return to 47th Ward Office
Attn: Deputy District Chief Jeffrey Lyle
Coordinator of Special Events
I am requesting a C.F.D. fire truck or engine at the following event:
TYPE OF EVENT:
DATE:
LOCATION:
*ALDERMANIC WARD:
TIME:
CONTACT PERSON’S NAME:
CONTACT PERSON’S PHONE NUMBER:
*NOTE: ALDERMANIC WARD MUST BE COMPLETED
I/we understand all C.F.D. equipment is considered “in service” meaning that should an
emergency situation occur it will take priority, and C.F.D. will respond to that incident.
The C.F.D. will not turn on fire hydrants or gives rides.
Confirmation for block parties can no longer be provided. The C.F.D. will make every attempt to
honor all Block party and special event request.
Date Received
CHICAGO
JUMPING JACK INFLATABLE
REQUEST FORM 2015
EMAIL APPLICATION TO:
or MAIL APPLICATION TO:
Initials
Time Scheduled
Initials
[email protected]
Chicago Department of Cultural Affairs and Special Events
78 East Washington Street - 4th Floor, Chicago, IL 60602
OFFICE USE ONLY
JUMPING JACK INFLATABLES ARE AVAILABLE ON A FIRST-COME-FIRST-SERVED BASIS
SATURDAYS AND SUNDAYS ONLY
BEGINNING MAY 23, 2015 THROUGH AUGUST 30, 2015
Please note that rules and regulations have changed significantly for the season.
RULES AND REGULATIONS. Please initial each rule.
Applications will be accepted beginning at 9am on Wednesday, April 1, 2015 via email: [email protected] or fax:
312-742-2783 or in person at the Department of Cultural Affairs and Special Events (DCASE). No applications will be accepted PRIOR to
this date. ____
2. Inflatables will only be provided to residential block parties within the city limits of Chicago. Events on private property, in parks, in forest preserves,
private parties, birthday parties, schools and festivals are not eligible to apply. ____
3. Inflatables are for outdoor use only. ____
4. Inflatables can only be set up on pavement, asphalt or concrete. ____
5. Applicants will receive notification by email or phone on the status of their request. The contracted provider will call to set up deliveries. ____
6. Approved block parties will receive an inflatable for (4) hours between the hours of 10am and 6pm on the scheduled day. Actual hours will be
determined by availability. Only one inflatable will be delivered to a requesting block party. ____
7. The requesting party will be required to provide a driver’s license or credit card information as a security deposit and designate an adult to sign for the
inflatable upon arrival. If inflatable is damaged during use, the credit card provided will be charged for damage. Inflatables will not be dropped off without
credit card information or a driver’s license and signature of a designated adult. ____
8. The inflatable will not be set up during inclement weather (rain, high winds, etc.). ____
9. The contracted inflatable company must be able to drive directly to the set up site. The inflatable cannot be transported manually. If the site is not
accessible by vehicle, services will not be rendered. ____
10. Generators are not provided. It is the responsibility of the requesting party to supply electrical power (120 watts) to operate the inflatable within
100 ft of the inflatable. ____
11. All parked vehicles must be removed from the location of the inflatable. Applicants are responsible for securing all necessary street closure permits from the
Aldermanic Office in that ward. ____
1.
PLEASE COMPLETE INFORMATION BELOW AND EMAIL TO:
Jumping Jack Program - Email : [email protected]
Chicago Department of Cultural Affairs and Special Events, 78 East Washington Street - 4th Floor | Chicago, IL 60602 | Fax: 312-742-2783
Name of Applicant:
On-Site Contact:
(Name) Required*
(Cell Phone) Required*
(Home Address) Required*
(Zip Code) Required*
(Email) Required*
Secondary On-Site Contact:
(Name) Required*
(Home Address) Required*
(Cell Phone) Required*
(Zip Code) Required*
(Email) Required*
Day and Date of Block Party:
(Day of the Week)
(Month)
Ward in which Jumping Jack Inflatable is appearing:
(Date)
Approx.# of children attending:
Required*
Please estimate
I certify that I am requesting a Jumping Jack Inflatable for a residential block party and have read each of the 2015 rules and
regulations above. DCASE reserves the right to cancel this agreement if the rules are not met.
Printed Name:__________________________________________ Signature: _______________________________________Date: _________________
Required*
Required*