KING FIRE & EMERGENCY SERVICES APPLICATION/PERMIT FOR FIREWORKS DISPLAY

KFES-FORM-FES-112

Applicant Information

First Name*field type single line
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Last Name*field type single line
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Name of Organization*field type single line
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Address*field type single line
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City/Town*field type single line
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Provincefield type single line
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Postal Code*field type single line
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Email*field type email
Telephone Number*field type single line
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Purpose of Event*field type single line
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Location of Event*field type single line
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Date of Event*field type date
Time (from):*field type time
Time (to):*field type time
Name of Person Supervising Setting Off of Fireworks at the Display:*field type single line
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Telephone Number*field type single line
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Insurance Company*field type single line
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Policy Number*field type single line
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Insurance Agentfield type single line
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Insured Amount*field type currency
$($5,000,000 minimum):
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Special Conditionsfield type multi line
Required Documents: Site Map, Permission Letter from the Venue, Copy of Insurance, Event Description, Fireworks Licence
Required Documents*field type file upload
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Council’s Written Approvalfield type file upload
for Event on Public Land (Pursuant to Section 4(b) and 5(e) of Fireworks By-Law Number 2015-114)
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By submitting this application, the applicant agrees to abide by the following terms and conditions:

SETTING-OFF DISPLAY FIREWORKS GENERAL PROVISIONS
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No Person shall set-off Display Fireworks without receiving a Permit through King Fire and Emergency Services.
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Display Fireworks shall only be set-off under the supervision of a person who is qualified for such purposes to the satisfaction of the Office of the Fire Chief.
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Every person who sets-off Display Fireworks shall take all steps reasonably necessary, as would a reasonable and prudent person, to ensure that no harm to persons or damage to property shall result.
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Conditions set out in the Permit as well as Legislative requirements at all levels of Government shall be adhered to.
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Property damage or injury as a result of Display Fireworks shall be the direct responsibility of the person setting-off the Fireworks. The responsibility of debris clean- up and disposal shall remain the direct responsibility of the person setting-off the Fireworks.
The applicant/agent acknowledges having read the Fireworks By-law (Fireworks By-law), and agrees that the Corporation of the Township of King assumes no responsibility for loss of property or personal damage resulting from the aforementioned Display Fireworks event and hereby agrees to indemnify and hold harmless the Township for any and all claims whatsoever arising therefrom.
PERMIT MUST BE AVAILABLE AND ON_SITE AT ALL TIMES

By submitting this application, the applicant affirms that the facts set forth in this document are true and complete to the best of my knowledge, and I agree to abide by the terms and conditions.
Full Name*field type single line
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Signature*field type signature
Datefield type date
Date will be captured on form submission
Notice of Collection: Personal information (PI) is collected under the authority of the provisions of the Fire Prevention and Protection Act and will be used for the process of application to issue a permit for Fireworks Display. Personal information (PI) will be protected in accordance with Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Questions about the collection of personal information (PI) should be directed to Fire Chief, Township of King, 2585 King Road, L7B 1A1 or Fire Chief at (905) 833-5321.

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