City of London - Special Event Request Form

Section 1 - Organization Information

Name of Organization (should be the same as listed on your insurance policy)

Main Contact (signing officer for the organization)

Main Contact (organizing event)

Organization Mailing Address (including city and postal code)

Primary Phone #

Secondary Phone #

E-mail address

Preferred method of communicationE-mail
Phone

Section 2 - Event Information

Name of Event

Start Date of Event

End Date of Event

How many attendees are expected in total for this event?

Description of Event

Will there be food vendors at this event?Yes
No

If you selected 'Yes', please indicate how many.

Will personal services be offered? (i.e., face painting, massages, hair braiding, etc.)Yes
No

Do you require additional amenities? Please note that these items may result in additional fees that the Special Events Coordinator will confirm before the event. Select all that apply.Garbage/Recycling Cans
Picnic Tables
Barricades
Bandshell (Harris Park and Victoria Park)
Grey Water Totes
Meter Bagging (Parking Spots downtown)
Tables and Chairs (Springbank Gardens only)
Thirstation or Thirstmobile

Section 3 - Event Location

If you selected 'Other Park', please indicate your preferred location:

Street Closure?Yes
No

Name of Street(s) to be closed (eg. Talbot St.):

Between which two cross streets are you requesting the closure? (eg. Dundas St. to York St.)

Showmobile Requested?Yes
No

Section 4 - Event Dates

**SETUP**

Setup Day 1

Start Time:

End Time:

Setup Day 2 (if required)

Start Time:

End Time:

**EVENT DAYS**

Day 1

Event Start Time:

Event End Time:

Day 2

Day Two - Event Start Time:

Day Two - Event End Time:

Day 3

Day Three - Event Start Time:

Day Three - Event End Time:

Day 4

Day Four - Event Start Time:

Day Four - Event End Time:

Day 5

Day Five - Event Start Time:

Day Five - Event End Time:

**CLEAN UP**

Day 1

Cleanup Start Time:

Cleanup End Time:

Day 2

Day Two: Cleanup Start Time (if required):

Day Two: Cleanup End Time:

Section 5 - Mandatory Event Details

Is your organization incorporated?Yes
No

If yes, please provide incorporation number:

Beer Garden?Yes
No

If yes, please provide security company details:

Inflatables/Bouncy Castles?Yes
No

If yes, please provide supplier details:

Do you require locates to be completed? (Large tents, inflatables, and stages that use ground piercing stakes require locates to be completed)Yes
No

If yes, please provide date(s):

Sound (speeches, music)? Please select all that apply.PA for public speaking
Live music
Recorded music/DJ

Do you need insurance through the City of London included in your park reservation?Yes
No

If no, please note that your insurance provider will be required to complete the City of London’s Certificate of Insurance form.

Will you be soliciting funds during this event?Yes
No

Are you a private/commercial organization partnering with a non-profit group?Yes
No

Please note upon event completion, a feedback survey will be sent to you.Yes, I have read that a feedback survey will be sent to me and I understand.

Thank you - please remember to click the SUBMIT button. A member of the Special Events Team will be in contact within 5-10 business days. Any general inquiries about this application should be emailed to specialevents@london.ca.