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2. A block party is defined as an event that is open to a specific/defined neighborhood or area; that is held no more than twice each calendar year within the same specific/defined neighborhood or area; where no admission fee is charged for attendance; where alcoholic beverages are not sold or where no entrance fee or admission is charged for service of alcoholic beverages; where a street closure, if necessary, shall not exceed twelve (12) consecutive hours; where the use of portable restroom facilities is not necessary. Any and all requests for temporary street closings require approval by the Waukee City Council.

4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip*
13. Email*
14. Home Phone
16. Business Phone
17. Cell Phone
19. Street(s) requested to be temporarily closed for block party, including termination points *
    (Example: Main Street between 1st Avenue and 3rd Avenue)
21. Date(s) Requested for Block Party*
    Date(s) Requested for Block Party
22. Alternate Date(s) Requested
    Alternate Date(s) Requested
24. Start Time of Block Party*
    Start Time of Block Party
25. End Time of Block Party*
    End Time of Block Party
27. Will there be outdoor live or amplified music? *

    If “yes,” please be aware of noise equipment provisions in Waukee Municipal Code 52.04(17).

    1. Yes

    1. No
29. Have all neighbors within the enclosed area and/or impacted by the temporary street closing been notified of the event?*

    1. Yes

    1. No
31. CITY BARRICADE REQUIREMENTS
    A $250 refundable deposit is required for barricades. All block parties within the City of Waukee are required to use barricades provided by the City of Waukee. The Waukee Public Works Department will deliver barricades on the weekday prior to the block party at the address listed provided. Please return the barricades to the same address to be picked up the weekday following the block party. The barricade deposit shall be refunded at the sole discretion of the City of Waukee. Submit $250 cash or check made payable to City of Waukee to City Clerk, Waukee City Hall, 230 W. Hickman Road, Waukee, IA 50263.
33. Signature*

    I have been advised of the requirements for a Block Party Permit and agree to meet all requirements established by the City of Waukee. Furthermore, I understand that if all requirements are not met, the Block Party Permit can be cancelled by the City of Waukee at any time, including at the start of or during the event. In the event that an organization is the applicant, I hereby certify that I have the legal authority to represent the applicant and/or the participants, and that I have read the above requirements, understand the provisions, and freely and voluntarily sign it. I further understand that the City Council of the City of Waukee has the authority to grant or deny permission for this event.
    
    I further voluntarily assume all risk of loss, damage, or injury that may be sustained by me or my guests while participating in, traveling from, or observing any of the events that are part of the block party, and I hereby release the City of Waukee and all its offices, elected officials, employees, and other agents from any and all liability associated with the block party.

    
    All picnic tables, inflatables, etc. must be placed on ONE side of the street within the approved temporary street closing area in the event that emergency vehicle access is needed.

    1. I Agree
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35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field