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2. Porter County Gatherings & Events COVID Non-Compliance Report Form
4. This form is to report non-compliance with requirements for current or upcoming Gatherings & Events
6. Please be sure to read the requirements for Gatherings & Events at this link BEFORE you submit this form.
   READ REQUIREMENTS HERE
8. Your Contact Information
   This information is required. We will only contact you if we have further questions about your report.
10. First Name*
11. Last Name*
13. Your Email Address*
14. Your Daytime Phone Number*
16. How would you prefer that we contact you if we have further questions?*

    1. By Email

    1. By Phone

    1. Either
18. Gathering Or Event Information
    Please provide the following information about the gathering or event you are reporting.
20. Are You Reporting....*

    Please Check The Appropiate Option.

    1. An Event You Attended.

    1. An Upcoming Event
22. Gathering or Event Name*
24. Who Was or Is The Organizer Of The Gathering Or Event?*
    If you are not sure, please enter "Not Sure".
26. What Is The Name Of The Venue Where The Gathering Or Event Was Or Is Being Held?*
28. Venue Street Address*
29. City*
31. What Was Your Source Of Information Regarding The Non-Compliance Of The Upcoming Event?*
33. Describe The Non-Compliance Issue(s) You Are Reporting. Please be as specific as possible.*
35. What Is The Date Of The Upcoming Event That You Are Reporting?*
    What Is The Date Of The Upcoming Event That You Are Reporting?
37. What Date & Time Did You Witness The Non-Compliance Issue(s)?*
    What Date & Time Did You Witness The Non-Compliance Issue(s)?

    What Date & Time Did You Witness The Non-Compliance Issue(s)?
39. All fields in this form REQUIRE an answer. Please be sure to verify that you have answered all questions before you submit this form. You will not be able to submit this form unless all questions are answered.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

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