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Firework Application

  1. APPLICATION & PERMIT TO DISPLAY FIREWORKS FOR ENTERTAINMENT PURPOSES*

  2. Include City/State/Zip

  3. *The fireworks display will be authorized by the Lake Country Fire & Rescue Department, Delafield Police Department and Mayor, and based on the following criteria:

    1. The Lake Country Fire & Rescue Department Fire Chief or his/her designee will inspect the location/display/detonation area and grounds prior to the display of fireworks.

  4. 2. Proof of indemnity bond and/or adequate liability insurance shall be provided, $1,000,000. A true copy of the Certificate of Insurance is attached indicating that the Municipality, Lake Country Fire & Rescue Department and applicable associations, recreations or committees formed by the municipality to organize the “Event” named as additional insured on all liability policies.

  5. 3. I agree to release, indemnify, and hold harmless the City of Delafield from and against any loss, damage of liability, including attorney’s fees and expenses, incurred by the latter and their respective employees, agents, volunteers, or other representatives arising out of or in any manner relating to the manufacture, installation, firing or disassembly of any pyrotechnic equipment or device and/or the supervision and presentation thereof.

  6. By Submitting this form, you have read and understand the information in this application and will adhere to all rules and regulations set forth by the City of Delafield.

  7. Office Use Only

  8. Signature/Date

  9. Signature/Date

  10. Signature/Date

  11. Leave This Blank:

  12. This field is not part of the form submission.