Special Event Permit Application

Special Event Permit Application

Deerfield Township Parks and Recreation
This application and resulting permit reflect the agreed upon and intended use of Deerfield Township and/or private property. Only applicants who have an approved Special Event Request Form should complete this application.

The completed application must be submitted at least 90 days prior to the event. A Comprehensive Site Plan and Insurance Certificate must accompany this application.

Any changes to the initial application must be made a minimum of 30 days prior to the event, and require additional review by Deerfield Township Staff.

Additional permits may be required for specific features of an event, such as fireworks, tents, structures, etc. The need for supplemental permits will be noted throughout the application. It is the responsibility of the applicant to ensure that all required permits are obtained. Deerfield Township reserves the right to revoke or terminate a permit if the applicant fails to obtain all permits required by law.
Special Event Request Code:*
For questions, please contact Sarah at skirby@deerfieldtwp.com or 513.701.6977.
Please select the carrot (gray triangle) to the right of each section title. This will open the section and allow you to view and complete the questions.

Please complete sections in order. Answers impact the visibility of questions in future sections. (For example: If you select a park with formal sports facilities, then additional questions will be required regarding use of the fields in later sections.)

Please do not skip sections. If an item does not apply to your event, please open the section and answer the questions accordingly.

Section 1: Contact Information
(Contact noted below must be on site during the event.)
Organization Name:*
Contact Name:*

First NameLast Name
Contact Phone:*

Area CodePhone Number
Contact Email:*

Section 2: Event Information
Event Name:
Event Description:
Location:

Carter ParkCottell ParkFleckenstein ParkKingswoodRobert's ParkSchappacher ParkOther
Event Start Date:

MonthDayYear
Date
Event End Date:

MonthDayYear
Date
Event Start Time: (For Public)

:HourMinutesAM/PM Option
Event End Time: (For Public)

:HourMinutesAM/PM Option
For events that are open to the public on multiple dates and that do not start/end at the same time each day, please note the start/end times associated with each date.
Set Up Date:

MonthDayYear
Date
Set Up Start Time:

:HourMinutesAM/PM Option
Set Up End Time:

:HourMinutesAM/PM Option
Tear Down Date:

MonthDayYear
Date
Tear Down Start Time:

:HourMinutesAM/PM Option
Tear Down End Time:

:HourMinutesAM/PM Option
Additional Comments:

Section 3: Event Fee / Anticipated Attendance
Will a fee be charged for this event?

YesNo
Anticipated Daily Attendance:
Comments:

Section 5: Security / Road Closures
Will roads need to be closed for the event?

YesNo
Roads Impacted:
Is YOUR ORGANIZATION hiring off-duty police officers or a private security firm for this event?

Off-Duty Police Officer(s)Private SecurityBoth Off-Duty Police Officers and Private SecurityNone of the aboveOther
Number of personnel YOUR ORGANIZATION is hiring:
Private Security Company Name:
Private Security Contact:

First NameLast Name
Contact Phone Number: (event day phone number)

Area CodePhone Number

Section 7: Food / Beverages
Will food or beverages be sold?

Food onlyBeverages onlyBoth Food & BeveragesNo, we will not be selling food or beverages.
Please contact the Warren County Health Department at 513.698.1228 for a food service permit.
Will alcohol be served or sold?

Serving AlcoholSelling AlcoholNo, there will not be alcohol at our event.
Please contact the Ohio Department of Commerce, Division of Liquor Control at 614.644.2411 for a liquor permit.
Will there be open flames or cooking?

YesNo
Please explain the open flames/cooking:
Please list the names of any food/beverage vendors that you will be using for your event:

Section 8: Restrooms / Dumpster
Will dumpster usage be required?

YesNo
Dumpster usage explanation:
The event organizer is responsible for maintenance, damage, and supplies for public restrooms or obtaining portable restrooms.

Public restrooms are available at the following parks: Cottell Park, Fleckenstein Park, Schappacher Park.
Will YOUR ORGANIZATION provide portable restrooms for your participants?

YesNo
Quantity of portable restrooms that YOUR ORGANIZATION will provide.
Additional Comments on Restrooms:

Section 9: Tents / Temporary Fencing
(All features must be indicated on the site plan.)
A separate permit is required for closed-sided tents 400 square feet or larger and open tents 700 square feet or larger.

1) A Zoning permit is required from Deerfield Township, who may be reached at 513.701.6958.

2) Once the zoning permit is approved, a permit can be obtained from the Warren County Building Department, who may be reached at 513.695.1290.

3) Tent stake locations should be marked in white paint one week prior to the event. Please contact OUPS (Ohio Utilities Protection Service) at 1.800.362.2764 for utility locations at least three working days before the tent is to be erected.
Will the event include tents or canopies?

YesNo
Will your event include any of the following?

Closed-sided tents 400 square feet or largerOpen tents 700 square feet or larger
Tent Company:
Company Contact Name:

First NameLast Name
Contact Phone:

Area CodePhone Number
Contact Email:
Will temporary fencing be used?

YesNo
Please explain use of temporary fencing:
The location of temporary fencing should also be indicated on your site plan.

Section 10: Amplification / Electrical Services / Water Service
(All features must be indicated on the site plan.)
Will amplification (speakers, sound systems, etc.) be used?

YesNo
Please explain use of amplification.
Is water service required?

YesNo
Please explain water service required.
Will Electrical Services/Generators be used?

YesNo
You will need to apply for an Electrical Permit from Warren County.
Electrical Services Company Name:
Contact Name:

First NameLast Name
Contact Phone:

Area CodePhone Number
Contact Email Address:

Section 11: Carnival/Amusement Rides, Inflatables, Fireworks
(All features must be indicated on the site plan.)
Prior to operation, all Carnival/Amusement Rides and Inflatables must be inspected and licensed with Ohio Department of Agriculture, Division of Amusement Ride Safety. Please contact the Division of Amusement Ride Safety at 614.728.6280 for questions on applicable permits, inspections, and licensures.
Will the event include any of the following?

Carnival/Amusement RidesInflatablesNone of the above
Company Name:
Contact Name:

First NameLast Name
Contact Phone Number:

Area CodePhone Number
Contact Email Address:
Fireworks must be done by a State of Ohio licensed Pyrotechnician, who must provide State permit forms for approval by the Fire and Police Chiefs. The organizer shall supply Insurance information. The Fire Marshall is required to be present at the expense of the event organizer. For more information, please call the Fire Department at 513.701.6989.
Will the event include Fireworks?

YesNo
Company Name:
Contact Phone Number:

Area CodePhone Number
Contact E-mail Address:

Section 14: Certification
I understand that selecting a check box or entering my name constitutes a legal signature confirming that I acknowledge and agree to the terms and conditions.

I understand and agree.
I certify the facts set forth in the Special Events Permit Application are true and complete to the best of my knowledge.

I understand and agree.
I understand that a Special Event Permit is not approved until Deerfield Township issues a permit number AND the permit has been signed by both Deerfield Township and the Grantee.

I understand and agree.
I authorize Deerfield Township to investigate my background, or the background of any person or entity names in the application. Deerfield Township is hereby authorized to make any investigation of information provided in this application.

I understand and agree.
I understand that additional permits may be required and that it is my responsibility to obtain all permits required by law. Deerfield Township reserves the right to revoke or terminate the Special Event Permit if I fail to obtain all permits required by law.

I understand and agree.
The undersigned represents, stipulates, contracts, and agrees, for himself and the organization stated above, that he and said organization, jointly severally will indemnify and hold Deerfield Township harmless against liability for any and all claims for damages to property or injury to, or death of persons arising out of or resulting from the issuance of the permit or the conduct of the participants.
Applicant Name (Please note that entering your name constitutes a legal signature.)

Special Event Permit Application

Section 15: Application Status