Orlando Police Department
NATIONAL NIGHT OUT GOES TO CHURCH REGISTRATION FORM
Mail or fax this completed form no later than July 6, 2012 to:
Orlando Police Department, Neighborhood Watch Unit, P.O. Box 913, Orlando, FL 32802-0913
Fax: 407-246-4227 or email to
REGISTRANT INFORMATION
First Name: / Last Name:Address:
City: ORLANDO / State: FL Zip Code:
Office Phone: / Other Phone: / Fax Number:
Email Address:
Church: / Commissioner District:
Pastor name: / NNO organizer name:
BLOCK PARTY INFORMATION
Party location (please be specific):______
______
______
Street Closure:
No _____ *Yes _____
*If you are closing the street for your block party, please complete the enclosed permit application and return to OPD with the registration form.
Will your event be open to the public? ______
Party start time: ______Party end time: ______ / Estimated number of children participating: ______
Total estimated number of attendees: ______
How do you plan to advertise your party?
National Night Out Goes to Church Party Plan Narrative
Party Theme Name:______
List the participating members and/or citizens and their role at the party:
1.______
2.______
3.______
List the type of entertainment, such as music/ clowns/ face painters etc:
1.______
2.______
3.______
Please narrate how the party theme will be developed, linking it to Crime Prevention:
______
______
______
______
______
List your sponsors, if any:
1.______
2.______
List other agencies participating and type of involvement:
1.______
2.______
List your means of promoting the party:
1.______
2.______
List your give-a-ways (except those provided by Neighborhood Watch):
1.______
2.______
Did you participate in NNO Goes to Church in 2011? ______
Would you like an Orlando Police Department Officer to come out and give a 15 minute safety presentation to your congregation before National Night Out? ______If you indicate yes, someone from the Crime Prevention Division will contact you to set a date and time.
Please include a copy of your flyer for your National Night Out Party!!
For further questions please contact: Georgeanna Butler at 407-246-3628 or by email to