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2. Name of Applicant
3. Address of Applicant
5. Phone
6. Email
8. Date
   Date
9. Rain Date (if applicable)
   Rain Date (if applicable)
10. Time of Party
    Time of Party Start Time

    —

    Time of Party End Time
12. Location of Party
14. Intersections of
16. Will alcoholic beverages be served?

    1. Yes
    2. No

    If yes, they shall be served on private property and no one under legal age may be served.
18. Meet and Greet Request

    1. Bloomfield Police Department
    2. Bloomfield Fire Department

    Would you like to Meet and Greet the Bloomfield Police Department and Bloomfield Fire Department? Officers and Firefighters will stop by your block party, if requested.  Please check either or both boxes if you like this addition to your block party.

20. Police Barricades
    Who will erect and take down police barricades that the Bloomfield Police Department in conjunction with the Bloomfield Department of Public Works will furnish to you?
22. Name
23. Phone
25. Address
27. Date Barricades Delivered
    Date Barricades Delivered
28. Date Barricades Picked Up
    Date Barricades Picked Up
30. The applicant understands that in the event of an emergency within the barricaded area (block party), emergency vehicles will have immediate access to the location of the emergency. The applicant further agrees that only one side of the street will be used for tables and chairs to provide access for emergency vehicles.
Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field