By submitting this form, I acknowledge that I have read, understood, and agree to the City of Adel Special Event Hold Harmless Agreement. I hereby certify the above statements are true and correct, to the best of my knowledge, and that false statement(s) may be grounds for denial of the application. It is understood the activities at all times during the event shall comply with all applicable federal, state, county, and City laws and regulations. It is further understood that the individual, organization, association, and / or block party organizer will be responsible for any and all damages arising as a result of this event. In accordance with the executed Indemnification and Hold Harmless Agreement, the applicant hereby waives any and all claims which the applicant may have as a result of this event against the City of Adel, Iowa, its officers, agents, employees, or board members. I have been advised of policies and procedures for the conduct of a block party in the City of Adel and I, or the organization I represent, have met or will meet all requirements established by the City. Further, I understand that if all requirements are not met, the Block Party and Street Closure Permit may be canceled by the City at any time including at the start of or during the event. If this event is sponsored by an organization, I hereby certify I have the legal authority to represent the applicant and / or the participants, and I have read the requirements for issuance of the permit and the Hold Harmless Agreement, understand their provisions, and freely and voluntarily sign (submit) this application.