This form is a supplementary document required to be included with every Special Event application submitted to the Town of Fountain Hills for review. This form will not be accepted or considered administratively complete unless an appropriate response is entered for each blank field below.

Section 1: Event Summary

Event Name *

Event Date *

Event Time (e.g., 7:00am-5:00pm) *

Number of Anticipated Attendees *

Location of Event (e.g., Fountain Park, Golden Eagle Park) *

Address of Event *

City *

State *

Zip *

Number of Merchandise Vendors *

Number of Food Vendors *

Section II: Required Health and Safety Measures

Complete the following section by reading each statement and initialing your acknowledgement and agreement below.

I have read the current guidance issued by both the Center for Disease Control & Prevention (CDC) and the Arizona Department of Health Services (ADHS) for mitigating the spread of COVID-19, as well as the State of Arizona Governor’s office executive orders regarding event requirements, and I agree to implement and enforce the adequate safety precautions during my event consistent with the guidance. *

I will ensure that all protocols and appropriate signage are used to limit contact between staff, vendors, and attendees, allowing attendees to maintain at least a six (6) foot distance from vendors and other attendees. *

I will ensure that all staff, vendors, and attendees are always wearing a mask or face shield within the event area, except for 1) children under two years of age, 2) persons with a medical reason preventing them from wearing a mask or face shield, or 3) attendees that are actively eating or drinking. *

I will ensure that all tables, chairs, or any other temporary structures used by staff, vendors, or attendees during the event are cleaned and disinfected before AND after each attendee’s use. *

I will ensure that handwashing sinks, hand sanitizing machines, and/or hand sanitizer will be made available and placed throughout the event area for staff, vendor, and attendee use. The number of hand sanitizing/washing stations available should be of sufficient number, based on the anticipated number of attendees detailed in Section I above. *

I will ensure that signage will be posted informing staff, vendors, and attendees that if they feel sick, or have been near people who have been sick within the past two (2) weeks, then they are not allowed to enter the event area. *

I will email a listing of event vendors, which includes contact information (name, email, phone, mailing address) to LicenseEnforcement@MesaAZ.gov at least three (3) business days prior to my event date. *

I understand that I must provide a listing of all food vendors attending my event to the Maricopa County Environmental Services Department by using their Special Event Coordinator web form at https://www.maricopa.gov/5339/Food-Permits. *

I will ensure that at least one (1) designated staff member or responsible party will continuously roam and monitor the event area to enforce the health and safety measures in this Mitigation Plan. *

Section III: Event Specific Health Protocols

Complete the following section by reading and initialing your agreement to the below statement and providing the requested information.

To ensure that my event remains in compliance with Arizona Executive Order 2020-59, and the CDC and ADHS guidelines, relating safety precautions for mitigating the spread of COVID-19, in addition to the required health and safety measures listed above in Section II, I will enact and enforce the following additional protocols. (Please provide details in the space below or in a separate attachment) *

Section IV: Signature and Certification

I hereby certify that all answers and information provided on this form are true and correct. Any false, misleading, or incomplete information constitutes grounds for denial of my Special Event application.

Name (Printed) *

Date *

Signature *

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