Action Center / MCHD Application for Exemption from the Gathering Size Limitation / Monroe County, IN

Monroe County Health Order 7/22/20
Governor Holcomb Executive Order 20-36, https://www.in.gov/gov/2384.htm
- Continuation of Indiana Back on track Stage 4.5

Gathering size limits are currently restricted in Monroe County by local and state orders due to the coronavirus pandemic. Those wishing to have a gathering larger than the current limits can request an increase by submitting the application below

A copy of a state issued ID is required to process this application. Please send a picture of the ID by email to covidexemptions@co.monroe.in.us. Include the ticket number received after submitting this form on the subject line as well as the Applicant’s last name.

Submissions are due 14 days before the event. The submission of an application does not mean it is approved.

Applications will be reviewed no more than one month before the event. Reviews will include the purpose and need of the request, the prevention strategies employed, and current evidence of community COVID 19 disease transmission.

Note: Exemptions may be limited based on the level of community disease spread at the time of the request and events may be subject to cancellation based on outbreak status.

By submitting this application, I confirm that all of the information is true and accurate.

Applicants will be notified by email of request approval or denial.

* Denotes a required field

Responsible Party Contact Information

Full Name

Address

Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

If the Responsible Party is not the property owner, please list the Property Management or Owner's name, address and contact information:

Property Management or Owner's Name

Property Mgt. Owner Address

Property Mgt. Owner Phone

Phone Area Code-Phone 3-Phone 4 ext Extension

Property Mgt. Owner Email

Event Information

Please describe the type of event?*

What is the purpose of the event?*

Why do you need an exemption?*

Maximum number of people that will be allowed at the event?*

Date/s of Event for which you would like the Exemption?*

Characteristics of Location

Location for which you are requesting Exemption from Size Limitation?*

Will the Gathering be inside or outside?*

Inside

Outside

Size of area for Gathering in square feet?*

Increased Sanitation

Will hand washing stations be on site?*

Yes No

Please Describe

Will hand sanitizer be available?*

Yes No

Any additional relevant information?

Applicants will be notified by email of request approval or denial.

Monroe County, Indiana

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MCHD Application for Exemption from the Gathering Size Limitation

Responsible Party Contact Information

If the Responsible Party is not the property owner, please list the Property Management or Owner's name, address and contact information:

Event Information

Characteristics of Location

Health Screening

Increased Sanitation

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