Temporary Road and/or Sidewalk Closure Application

This request is to be submitted for the purposes of a temporary road and/or sidewalk closure for a Special Event.

This application must be submitted a minimum of four (4) weeks prior to the desired road/sidewalk closure date. Failure to submit your application on time could result in the event not recieving approval. 

Applicant Information (Contact Person)

Organization Information (If different from Applicant Information)

Description of Road Closure

Required Documentation

Additional documents deemed pertinent in the granting of this application may be required at the request of the Municipality of Leamington.

Hold Harmless Agreement/Indemnification Agreement

I, the undersigned, agree that I shall release, waive and forever discharge the Corporation of the Municipality of Leamington from all claims, demands, costs, expenses, in respect of death, injury, loss or damage; and that I shall at all times indemnify and save harmless the Municipality from and against any and all manner of claims, demands, losses, costs, charges, actions and other proceedings whatsoever made or brought against, suffered by, or imposed on the Municipality as a result of the Applicant’s event.

Declaration

I, the undersigned, do solemnly declare that all information provided in and with this application is factual and correct and agree to abide by and adhere to all relevant by-laws, rules and regulations, matters and things as are, or may be enacted by the Municipality of Leamington, and to any applicable federal or provincial legislation or regulation in effect, enacted, or amended, from time to time, and make this solemn declaration conscientiously knowing that it is of the same force and effect as if made under oath.

Privacy Statement: Personal information on this form is collected under the authority of the Municipal Act 2001 P.S.O. c45, and will be used for the purpose of processing a special event application and permit. Questions about the collection of this information can be directed to the Manager of Legislative Services/Clerk, Municipality of Leamington, 111 Erie Street North, Leamington, Ontario, N8H 2Z9, Telephone: 519-326-5761.