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Fireworks Display Permit Request

Please fill out the following information to request a permit to conduct a fireworks display as part of a school-related championship celebration.

Primary Contact Name*

Answer required for "Primary Contact Name"

Email*

Answer required for "Email"

Phone Number*

Number Required

Event Name*

Answer required for "Event Name"

Date of Fireworks Display*

Answer required for "Date of Fireworks Display"

Start Time*

Answer required for "Start Time"

End Time*

Answer required for "End Time"

Exact Location (address and description)*

Answer required for "Exact Location (address and description)"

Please describe the celebration, its connection to the athletic achievement, and how fireworks will be incorporated.*

Answer required for "Please describe the celebration, its connection to the athletic achievement, and how fireworks will be incorporated."

Detailed List of Fireworks to be Used*

Answer required for "Detailed List of Fireworks to be Used"

Confirmation that all fireworks comply with state and local regulations*

Answer required for "Confirmation that all fireworks comply with state and local regulations"

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Copy of a valid state-issues pyrotechnician/operation license*

Answer required for "Copy of a valid state-issues pyrotechnician/operation license"

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Proof that the operator is authorized to conduct public displays*

Answer required for "Proof that the operator is authorized to conduct public displays"

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Certificate of Insurance naming Eaton School District and the Town of Eaton as additional insureds including minimum coverage limits as required by local ordinance.*

Answer required for "Certificate of Insurance naming Eaton School District and the Town of Eaton as additional insureds including minimum coverage limits as required by local ordinance."

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Site diagram showing fallout radius and spectator areas*

Answer required for "Site diagram showing fallout radius and spectator areas"

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Crowd Control and Emergency Response Plan*

Answer required for "Crowd Control and Emergency Response Plan"

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Applicant Certification*

Answer required for "Applicant Certification"

I certify that the information provided is accurate and that all fireworks activities will comply with applicable laws, ordinances, and safety requirements.

Signature*

Signature Required

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"