COVID-19 Mitigation Measures for Organized Public Events

2. This form must be filled out for all organized public events over 50 people pursuant to <a href="https://azgovernor.gov/sites/default/files/executive_order_2020-59.pdf" target="_blank">Executive Order 2020-59</a> issued by Governor Doug Ducey to mitigate the spread of COVID-19.

   This form must be filled out for all organized public events over 50 people pursuant to Executive Order 2020-59 issued by Governor Doug Ducey to mitigate the spread of COVID-19.

4. Full Name*

6. Phone Number*

7. Email Address*

9. Mailing Address*

11. Mail Address cont.

13. City*

14. State*

15. Zip*

17. Event Details

19. Name of Event*

21. Where will the event take place? (i.e. park, community center, etc)*

23. Event Address*

25. Event Address cont.

27. City*

28. State*

29. Zip*

31. Start Date of Event*
    Start Date of Event

32. End Date of Event
    End Date of Event

33. Start Time of Event*

34. End Time of Event*

36. How many guests are you anticipating? *

38. Have you submitted, or are you planning to submit, a Temporary Use Permit Application for this event? *

    1. Yes

    1. No

40. What COVID-19 mitigation strategies will be implemented during the event?*

42. COVID-19 Mitigation Plan
    Please attach your detailed COVID-19 mitigation plan here. This will be posted to the city’s website for public viewing.<br><br> For reference, please view the CDC guidelines. The event must also meet any applicable requirements of the Arizona Governor’s Executive Orders and City of Surprise proclamations regarding COVID-19.

    Please attach your detailed COVID-19 mitigation plan here. This will be posted to the city’s website for public viewing.
    
    For reference, please view the CDC guidelines. The event must also meet any applicable requirements of the Arizona Governor’s Executive Orders and City of Surprise proclamations regarding COVID-19.

43. Guidelines:
    <a href="https://www.cdc.gov/coronavirus/2019-ncov/index.html" target="_blank">CDC COVID-19 Information</a><br><br> <a href="https://www.azgovernor.gov/executive-orders" target="_blank">Arizona Governor Executive Orders</a><br><br> <a href="https://www.surpriseaz.gov/Covid-19 " target="_blank">Surprise COVID-19 Information</a>

    CDC COVID-19 Information
    
    Arizona Governor Executive Orders
    
    Surprise COVID-19 Information

45. COVID-19 mitigation plan*

    Please attach your detailed COVID-19 mitigation plan here. This will be posted to the city’s website for public viewing.

47. Signature and Certification*

    By checking the box below, I hereby certify that all answers and information on this form are true and correct. Any false, misleading, or incomplete information constitutes grounds for denial of this registration.
    
    

    1. I agree that all the provide information is complete and true.
48. Date
    Date

Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field