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2. 
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Email Address*
16. Stage Name / Group Name*
17. Social Media
19. How Many Performers are in your group? *
20. Group/Performer Information:

    Please list the names of all the individuals in your group that will be performing. 

21. Are all the performers in your group over age 18? *

    1. Yes
    2. No

    Anyone under 18 years of age must be accompanied by an adult. If the adult is not a performer, they must supervise  the entire busking session. 

23. Description of Activity/Type of Performance*
    -- Select One --MusicDanceMagicCircus / RenaissanceOther
24. If you checked other, please describe your activity or type of performance here:
26. Description of Equipment Used: *
28. Will you be selling promotional products with your performance? *

    1. Yes
    2. No

    Please refer to the Busking Guidelines for rules/conditions related to selling products during your performance. 

30. Electronic Indemnification Agreement*

    1. I agree.

    By checking the '"I agree" box  you agree that: 

    1) I, the Applicant, will indemnify and defend the City of Anoka, its officials, agents, and employees ("the Indemnities") against any losses, costs, damages, claims, liabilities, claims, suits, actions, causes of action and expenses resulting from, arising out of, or relating to any negligence or intentional misconduct, its officers, employees, or any person under its control or in connection with this permit.  

    2) I, the Applicant, affirm that all answers given and statements made on this application are full and true to the best of my knowledge and beliefs. I have read the expectations and guidelines outlined in the document and will follow ALL applicable city and state ordinances. 

    3) Unless expressly provided for in the permit, Use & Event permits do not grant the permit holder exclusive rights to park, plaza  or sidewalk, or provides the right to restrict access to, use, or passage by, or the First Amendment activities of any person on any property open to the general public. 

32. Electronic Signature Agreement*

    1. I agree.

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

34. Electronic Signature*
35. Date Submitted*
    Date Submitted
37. 
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit Submit and Print

* indicates a required field