Thank You for Your Submission

2. 12 HOUR EVENT PERMIT APPLICATION

   This application is for those interested in booking the event center for an all day 12 hour event. If you prefer to book by the hour, view availability on the Hourly Rental Calendar. To reserve an all day event, and utilize both the Banquet Room and Conference Room, please complete the fillable form below and mail in venue payment. Checks can be written out to “City of Champlin” and mailed to: 

   Mississippi Crossings | 11955 Champlin Drive | Champlin, MN 55316

6. Name of the Event:
8. Estimated Guest Count:
9. Floor Plan Preference:
10. Type of Event (reception, birthday, reunion, etc.):
12. Event Set Up Date:
13. Time:
15. Actual Event Date(s):
16. Time:
18. Event Clean Up Date:
19. Time:
21. Event Location (Banquet Room | Conference Room | Both):
25. APPLICANT INFORMATION

    Responsible Person could be the Permit Holder, or it could be the day of event planner, and/or coordinator.

27. Permit Holder Name:
29. Home Address:
31. City:
32. State:
33. Zip Code:
35. Email:
36. Permit Holder Phone:
38. Responsible Person Name:
39. Responsible Person Cell Phone:
43. FOOD

    Will you serve food? Please list the vendor. Vendors need to be verified by the city for proper licensing and insurance 30 days prior to the event.

45. ALCOHOL

    Will you serve alcohol? If yes, staff will confirm an alcohol use permit and assist you in scheduling park patrol. All bar service vendors need to be verified by the city for proper licensing and insurance 30 days prior to the event.

47. SET UP & DECOR DETAILS

    It is required that all vendors are confirmed and verified by the city 30 day prior to the event. Please describe set up and clean up in regards to décor and/or signage. Will tents be requested?  Will staging be requested? Will additional power be requested (outside average use)? While you may not have details confirmed, please fill this section out to best of your ability describing your ideas for the space.

51. Electronic Signature Agreement

    I agree to abide by all applicable City Ordinances regulating special events and the use of public parks and/or facilities. I agree to indemnify and hold the City of Champlin harmless for any personal injury claims resulting from use of public property and/or organized public events. I agree to pay for all public safety costs. I agree to pay for any damage done to public property as a result of our group’s use of public property that exceeds the damage deposit. I agree that I am 25-years of age or older.

    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.

    1. I agree.
53. Permit Holder Electronic Signature
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field