Application for Special Event Request

2. Special Event Guidelines

   1. Any individual or group wishing to hold a special event in the Village of Pelham (utilizing or involving Village of Pelham Property) must file an application with the Village Clerk’s Office. 

   2. Any individual or group wishing to hold a special event in the Village of Pelham on Village property must provide a certificate of insurance listing the Village of Pelham as an additional insured at limits approved by the Village Attorney. 

   3. Any individual or group wishing to hold a special event in the Village of Pelham must sign a “hold harmless” or indemnification agreement with the Village. 

   4. The applicant will receive written confirmation from the Village Clerk’s Office when approval has been granted.

    5. The Police Chief, Fire Chief, Building Inspector, and General Foreman will be notified of the event by the Village Clerk’s Office. 

   6. For special events to be held on sidewalks, permission allowing the use of the sidewalk must be obtained from abutting merchant(s) and forwarded to the Village Clerk’s Office as part of this application. 

   7. Individuals or groups wishing to hold a block party must use the separate block party application.

   8. Applicants must comply with all applicable Village Code requirements including chapter 68-Peace and Good Order. 

   9. Pursuant to § 68-3 of the Village Code, the consumption of alcohol on public property is prohibited unless special permission is granted by the Village. 

   10. Complaints of non-compliance could result in disbanding the event and forfeiting the right to hold such events in the future

4. Name of Event*
6. Purpose of Event*
8. Contact Person*
9. Contact Email*
11. Contact Telephone #*
12. Contact Address*
14. Date(s) and Time of Event*
    Date(s) and Time of Event Start Date

    Date(s) and Time of Event Start Time

    —

    Date(s) and Time of Event End Date

    Date(s) and Time of Event End Time
15. Date 2
    Date 2 Start Date

    Date 2 Start Time

    —

    Date 2 End Date

    Date 2 End Time
17. Event Location*
19. Activities Planned*
21. Setup and Equipment
23. Special Requests/Comments
25. Insurance Coverage Date*
    Insurance Coverage Date
26. Insurance Coverage*

    Provide name of insurance carrier

27. Insurance Other Information
28. Insurance Documentation Upload
30. Indemnification Agreement*

    1. I, or an agent of the organization, will be required to sign an indemnification agreement, indemnifying and holding harmless the Village of Pelham.
31. Indemnification & Hold Harmless Agreement

    Indemnification & Hold Harmless Agreement download

    Please download, sign, scan and submit with this application a signed indemnification agreement. 

32. Signed Indemnification Agreement*

    Please submit with this application a signed indemnification agreement.

34. Other Supporting Documentation

    Please feel free to upload any additional supporting documentation including a letter of intent/detailed description of the event.

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field