Special Event Agreement Application

I have read, understood, and agree to abide by the Special Events Rules and Agreements provided, as well as those given to me verbally.

Organization/Company Name*:

Website:*:

First Name of Contact:

Last Name of Contact*:

Phone Number*:

( ) -

Address*:

City*:

State*:

ZIP Code*:

Organization/Company Guests*:

Up to five (5) Org./Company affiliated guests are permitted to support the event. The names included agree to all Special Events Rules and Agreements.

Extra Guests*:

Request additional five (5) guests

Specify your Special Event Proposal in Detail*:

Must engage the children in activity

Will there be a fundraising or donation component?*:

Yes/No. If yes, please explain.

Frequency of Event*:

One-time or monthly. If more, please specify.
Please note a new event form must be submitted for each event.

Will event have food and/or beverages?*:

Yes or No
If yes, please provide the donating location/Store Number and upload Certificate of Insurance of company providing food for approval.
You may also request catering services by our Food & Nutrition Department.

Upload Certificate of Insurance*:

Will Costumed Characters/Special Event Guest need security?*:

Yes/No. If yes, please specify.
Please include quantity of characters/guests.

Will Characters need access to a breakroom? If so, for how long?*:

Yes/No. If yes, please specify.

Please list any special requests*:

Yes/No. If yes, please specify.

Location of Event*:

To be determined by Nicklaus Children's Staff based on nature of event.

Proposed Date of Event*:

Proposed 2nd Date of Event*:

Estimated Value of Donation*: