Form Center

2. Block Party Organizer First Name*
3. Block Party Organizer Last Name*
5. Address*
6. City*
8. Province*
9. Postal Code*
11. Daytime Phone Number*
12. Email*
14. When was your block party held?*
15. Was this the first block party for your neighbourhood?*
17. Which block party did you apply for?

    1. Soccer Block Party with free screen rental
    2. Soccer Block Party ($500 grant)
    3. Block Party ($150 grant)
19. In the past, have you ever hosted a block party before?

    1. Yes

    1. No
20. How many have you organized?
22. How many people attended?*
23. How important were the grant OR screen options in your decision to host a block party?

    1. Very Important
    2. Somewhat Important

    1. Not Important
25. How did you spend the $150 grant?*
27. Did you find the Play Kit bag and / or the Activity Kit useful?

    1. Yes
    2. No
29. Describe the successes of your block party.*
31. Would you host another block party?

    1. Yes

    1. No
32. Please Explain
34. Comments
36. To receive the grant, send us up to three photos from your block party.

    If applying for a Soccer Block Party grant, please provide photos that capture Soccer Block Party elements.

38. Block Party Image 1*
40. Block Party Image 2*
42. Block Party Image 3*
44. The block party grant will be sent to the block party applicant by cheque in the mail within 5-8 weeks.
46. Collection and Use of Personal Information*

    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 Heidi Hughes – City of Coquitlam Tourism and Visitor Economic Manager at 604-972-3699.

    1. I consent
Leave This Blank:


48. 1. Receive an email copy of this form.
49. Email address

    This field is not part of the form submission.

50. Submit

* indicates a required field