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2. 
3. City of Middleton - Entertainment Club License
5. License Type*

   1. New

   1. Renewal
7. Business Name*
8. Premise Address*
10. DBA/Trade Name*
12. Does the establishment hold a liquor license in the City of Middleton*

    1. Yes

    1. No
14. Agent Name*

    Person responsible for the premise

15. Agent Phone*
17. Agent E-mail*
18. Upload Agent DL/ID*
22. Security Plan
24. Types of Live Entertainment*

    1. Live Music
    2. Disc Jockey
    3. Dance Floor
    4. Live Dancers

    Select all that apply

25. Type of Security*

    1. No Security
    2. Volunteers
    3. Non-security Staff Serving as Security
    4. Regular Security Staff in Distinctive Attire
    5. Outside Security Firm
    6. Sworn Law Enforcement Officers
    7. Middleton Police Officers
27. Crowd Control and Staffing
29. The number of patrons when there is not live entertainment*
30. Number of staff __ and/or approximate staff to patron ratio __*
32. For live entertainment events - the peak crow estimate is between ___ - ___ patrons*
33. Number of security personnel ___ and/or approximate security to patron ratio ___*
35. For live entertainment events - the peak crowd is anticipated between the time frame of ___ am/pm and ___ am/pm*
37. Security Plan Questions

    Please complete the questions or upload a document answering the questions below.

39. Answer questions 1-8 below or upload a document that answers them
41. 1. How will staff/security personnel be utilized?
43. 2. How will control and clearing of the parking lot be handled?
45. 3. How will unruly patrons be handled?
47. 4. How will intoxicated patrons be handled?
49. 5. How will patrons presenting false identification be handled?
51. 6. How will you supervise and control of patrons under the age of 21?

     For alcohol licensed premise, a means of visually and conspicuously identifying patrons who are 21 and older.

53. 7. Under what circumstances will the police will be called?
55. 8. How physical disturbances will be handled?
59. By applying for this license you consent to inspection of above stated premise by City officials, including but not limited to police officers, fire inspectors, and building inspectors at any time the club is open for business or upon reasonable notice. I attest that the above information is true and correct and that any false or incomplete information may result in denial of my application.
61. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
62. Initial here*
64. Please type name as shown on application above*
65. Date*
    Date
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field