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2. Block Party Organizer*
3. Address*
5. City*
6. Province*
7. Postal Code*
9. Daytime Phone Number*
10. Email*
12. When was your block party held?*
13. Was this the first block party for your neighbourhood?*
15. In the past, have you ever hosted a block party before?

    1. Yes

    1. No
16. How many have you organized?
18. How many people attended?*
19. How important was the $150 grant in your decision to host a block party?

    1. Very Important
    2. Somewhat Important

    1. Not Important
21. How did you spend the $150 grant?*
23. Did you find the Play Kit bag and/or the Block Party Handbook useful?

    1. Yes
    2. No
25. Describe the successes of your block party.
27. Would you host another block party?

    1. Yes

    1. No
28. Please Explain
30. Comments

32. To receive the grant, send us up to three photos from your block party. Please email them to blockparties@coquitlam.ca.

    
    

    The block party grant will be sent to the block party applicant by cheque in the mail within 5-8 weeks.

34. By checking "I consent" you are consenting to the voluntarily collection and use of your personal information in accordance with Section 26(d) of the Freedom of Information and Protection of Privacy Act. The information provided by you will be used solely for the purpose of registering for Block Parties. Your information will not be used for any other purpose. If you have any questions about the collection, storage, correction and or/use of your personal information please contact Karen Basi - City of Coquitlam Cultural Services Manager at 604-927-3599.*

    1. I consent
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36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

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