Borough of Glenolden

Delaware County, Pennsylvania

36 E. Boon Avenue

Glenolden, Pennsylvania 19036

Phone: 610-583-3221 Fax: 610-583-2040

Block Party Information & Opinion Response Form

IMPORTANT: BLOCK PARTY SPONSOR SHOULD COMPLETE THE SHADED AREAS PRIOR TO DISTRIBUTION. THE SPONSOR SHOULD DISTRIBUTE THIS FORM (OR PHOTOCOPIES) TO ALL RESIDENCES OF THE BLOCK (S) REFERENCED BELOW. A COPY OF THIS FORM SHOULD BE FILED AT THE BOROUGH OFFICE PRIOR TO ITS DISTRIBUTION.

SPONSOR/EVENT INFORMATION:

Sponsor’s Name_____________________________ Address__________________________

Date of Proposed Block Party___________________ Start time_______ End time_______

Rain-date (if applicable)_______________________ Start time_______ End time_______

Streets to be affected__________________________ between ____________ and ____________

Dear Glenolden Resident:

The above named sponsor has proposed a block party as described above. Prior to considering the request for approval of the block party and for the closing of affected Borough streets, Borough Council desires input from those persons who would likely be most affected by such an event, the residents of the block(s) in question. Please take a few moments to complete this form. If you have any additional comments, suggestions, or questions, please provide them on the back of this form. The completed form can be returned either to the sponsor or to Borough Hall at the address or facsimile number listed above.

Sincerely,

Glenolden Borough Council

RESIDENT INFORMATION:

Name____________________________________ Address_______________________

Check one: [ ] I SUPPORT the proposed block party.

[ ] I OPPOSE the proposed block party.

[ ] I have NO OPINION with regard to the proposed block party.

If approved, would it be likely that you would participate in the block party?

Check one: [ ] Yes [ ] No [ ] Unsure

Signature__________________________________________ Date______________

RESIDENT: USE REVERSE SIDE FOR ADDITIONAL COMMENTS, SUGGESTIONS, OR QUESTIONS.

PLEASE RETURN COMPLETED FORM BY _____________________________________.

(date)