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5. Nassau Bay Block Party Registration Form

   Registration is free and gives police and other city representatives an opportunity to attend local events as time and circumstances permit. National Night Out is for everyone! Once you register we will put your party on our list of sites to visit during the evening. 

   Block Parties must register by Wednesday, September 27, 2023, to ensure representatives will stop by. 

   The Nassau Bay Police Department will make every effort to visit as many events as possible, but we can't visit if you don't register. Completing this form will submit your registration information to the Nassau Bay Police Department. You can also register in person at 1800 Space Park Drive, Suite 200 in Nassau Bay.

7. Block Party Captain Name*
8. Block Party Co-Captain (if co-hosting)
10. Block Party Address*
12. Phone Number
13. Email Address*
15. Expected Party Start and End Time*
    Expected Party Start and End Time Start Time

    —

    Expected Party Start and End Time End Time
16. Expected Attendance
18. Block Captain Yard Signs

    This year, we will ask Block Captains to pick up their "Block Captains" yard signs from the Police Department before National Night Out on October 4th. These yard signs are to be displayed in your yard or party entrance so that your neighbors know where the party is located. Captains can come at any time during City Hall business hours (Monday through Thursday 7:30am to 5:30pm and Friday 7:30am to 5:30pm) to pick up a yard sign. We kindly ask Block Captains to return the signs to City Hall within three (3) days after October 4th, so that they may be used for future National Night Out events. 

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21. Yard Sign Pickup*

    Do you acknowledge that a Block Captain must pick up the Block Captain yard sign from the Nassau Bay Police Department prior to National Night Out on Tuesday, October 3rd? Signs will not be delivered to each National Night Out party.

    1. Yes, I acknowledge I need to pick up my Block Captain yard sign prior October 1st.
    2. I will not pick up a Block Captain yard sign.
22. Yard Sign Return*

    Do you acknowledge that you must return the Block Captain yard sign to the Nassau Bay Police Department within three (3) days after the event.

    1. Yes, I acknowledge that I need to return the Block Captain yard sign with three (3) days after the event.
    2. I will not pick up a Block Captain yard sign, therefore will not need to return a sign.
24. Block Captain Recognition at City Council on October 10th*

    The City of Nassau Bay is so appreciative of the support towards building police-community partnerships. Every year Mayor and Council recognizes those individuals who went above and beyond in hosting a block party for our community and neighbors. This year, we would like to invite each National Night Out Block Captain to our Monday, October 9th City Council Meeting (at 7:00pm) to be recognized.

    1. I will be in attendance to be recognized at the October 9th City Council meeting.
    2. I am unable to attend.
26. Name of Individuals in Attendance on October 9th

    Please type in the names of the individuals who will attend the October 9th City Council meeting.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field