Include a list of roads to be closed and the corresponding intersections; a legible map of the closure areas and / or event site including placement of volunteers and personnel, assembly areas, route of parade (if applicable); description and indication of all on-site directional and promotional signage.
Describe plan for use of Township lots, non-Township lots, public and / or private lots. Include any request for removal of on-street parking.
Event organizer is responsible for providing and servicing portable restrooms during events when permanent facilities are not available or deemed not adequate by Liberty Township for the estimated attendance.
Applicant declares all information submitted on this application is true and accurate. Applicant will immediately notify the Events Coordinator of any additions or changes that arise after application is submitted. Changes could result in denial or revocation of permit. On behalf of the above organization(s) and all members thereof, applicant agrees to abide by all policies, procedures and instructions set forth or provided by Liberty Township, its staff, officers and designated agents and will also comply with all relevant local, state and referral regulations.
It is the responsibility of the applicant to have the most up-to-date applications and / or requirements prior to submitting as changes may occur.
By checking this box I agree that the information I provided on this form is accurate to the best of my knowledge.
Application conditionally approved pending
On behalf of the above organization / group, I expressly waive, release and discharge Liberty Township, its officers, agents, and employees or any other persons from any and all liability for any death, disability, personal injury, property damage, property theft or actions, including any alleged or actual negligent act or omissions, regardless of whether such act or omission is active or passive which may accrue to myself or members of my organization / group or our heirs in connection with our participation in the above described event. I fully understand and acknowledge that Liberty Township is relying on my representation that I have authorization to sign this document and that I will provide all members of my group a completed copy of this Waiver prior to our participation.
I expressly indemnify and hold harmless liberty township, its elected and appointed officers, agents and employees from any and all liabilities or claims made by me or my organization / group, my / our heirs and any other individuals or entities as a result of any of my / our actions in connection with my / our participation in this event except for those claims arising from the sole negligence or sole willful conduct of the township, its officers, employees, volunteers or other representatives. Such indemnification includes liability settlements, damage awards, costs and attorney fees associated with any such claims.
I hereby certify that I have read this document, understand its content, and am authorized to sign this document on behalf of all members of the group I represent.
I agree that the information I have provided is correct and to the best of my knowledge.
This field is not part of the form submission.
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