Randolph Civic Foundation Block Party Sponsorship Request
Please complete the following for
Requestor's Name
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Requestor's Phone Number
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Requestor's Email Address
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Requestor's Address
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Date of planned event
MM
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DD
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YYYY
Do you plan to close blocks for your event?
If yes, which blocks?
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Have you obtained approval from other households on your block?
Please describe your plans for the block party (activities, food, etc)
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How many attendees do you anticipate at your event?
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How many other households are assisting in the planning of the event?
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By entering my name below, I hereby certify that the information contained within this application is truthful to the best of my knowledge. I further certify that I will obtain a county permit for the proposed block party and abide by the rules therein. I understand that, if my request is approved, the Randolph Civic Foundation will reimburse participants in the proposed block party up to a total of $150 for food, non-alcoholic beverages and entertainment, and that I will not receive reimbursement until I provide receipts. I certify that funds obtained through this request will be used for the stated lawful purposes. *
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