677 Ala Moana Blvd.
Suite 1001
Honolulu, HI 96813
Tel: (808) 587-2870
Fax: (808) 587-8150
 
NEW PARK PERMIT REQUEST FORM

NEW PARK PERMIT REQUEST FORM

ALL APPLICANTS MUST BE EIGHTEEN YEARS OF AGE OR OLDER

As the Applicant, I hereby certify that the information I have provided on the form is complete and accurate to the best of my knowledge. I agree to abide by the terms set forth in this application and HCDA guidelines. I understand that failure to do so may lead to the cancellation of the event, the denial of future permit applications, or other action by HCDA.

Please fill in all blanks, mark 'N/A’ if it doesn’t apply.

APPLICANT INFORMATION

Applicant Name:
Email Address:
Address:
City, State, Zip Code:
Phone Number:
Business or Cell Phone:
Organization (if applicable):
Phone Number:
Emergency Contact Name:
Phone Number:
Names, addresses and daytime phone numbers of two organization officers besides applicant (if applicable):
List any previous park events organized by applicant/organization (include locations and dates):

EVENT INFORMATION

Type of Event:
Date of Event: //
Raindate: //
Name of Park:
Location in Park:
Number of Participants:
Number of Spectators:
Set-up Begins: //   : 
Clean-up Ends: //   : 
Time Event Begins: //   : 
Time Event Ends: //   : 
Will participants or spectators be charged? YES  NO
If so, how much?
Describe in detail all activities planned. List all items to be distributed. (Sale or distribution of food, products, promotional material, celebrities, speeches, ceremonies, etc.)
Will the event be advertised? YES  NO
If so, describe advertising plan, including dates and media outlets:
Will any pamphlets, handbills, or advertising matter of any kind be distributed at the event? YES  NO
Do you plan to drive vehicles onto park land (authorization required)? YES  NO
Will any items be offered for sale/donations to the public? YES  NO
Have you made any provisions for on-site medical services? YES  NO
Have you made any provision for on-site security? YES  NO
Do you plan to have amplified sound at your event? YES  NO
Do you have Insurance? YES  NO
If so, with whom:
University of Hawaii John A. Burns School of Medicine
The John A. Burns School of Medicine's Kaka'ako facility is the home for the school's education and research activities. Two mid-rise buildings are designed to facilitate and support the dual mission of the school.
JABSOM Facility