Incident Report – Farm Block

2239 N. Farmers Block Rd.
Allouez, MI 49805

Where the incident(s) took place?

On festival grounds Outside festival grounds Other

When the Incident took place (if you are unsure of the exact date and time, please provide an approximate time)

When and where did this incident take place? Please share the specific date, time, and location (i.e. The specific location if at Farm Block, or the equivalent if outside of festival grounds).

What happened? Please share a detailed description of the incident(s) you want to bring to our attention. (i.e. What boundaries were crossed? What felt uncomfortable, inappropriate, or suspect?)

Who else was involved? (i.e. the boundary crosser and/or the impacted person (if not you)). If you don't know their name(s), or if you wish to keep their identity confidential, please state so here. Alternatively, if you would like us to follow up with them, please give their name(s) and any contact information you have for them.

Did anyone else witness this incident or behavior? If so, and if you are open to sharing-- who? We welcome names or other identifying information.

Where the incident(s) took place?

Yes No Undecided Other

Do you feel unsafe around the person(s) involved in the incident(s)?

Yes No Undecided Other

What sort of response would you like?

I would like a facilitated mediation or clearing conversation with the person(s) involved. (We offer mediation based on the 4 A's Of Accountability model.) I would like to speak with someone on the Farm Block Consent Team about this privately. I would like for you to look into this on my behalf, and follow up with the involved parties. I would like to report and request that the person(s) be removed or barred from festival premises. I just want you to know about the incident, no follow up is needed. Other

Do you want to remain anonymous?

Yes No

Is there anything else you would like to add?

Your Name (optional) - please include this info if you want us to contact you

Your Email (optional) - please include this info if you want us to contact you

Your Cell Number (optional) - please include this info if you want us to contact you during the Festival

Is it ok to leave you a voicemail?

Yes No

10% of sales to benefit the Dan Schmitt Gift of Music and Education Fund.

Use this form to report consent incidents (including boundary-crossings, inappropriate behavior, harassment or violations of the community’s Consent Code of Conduct) that you have experienced or witnessed. No incident is too big or too small. Reporting builds awareness, strengthens our community and empowers others to do the same.

All of your answers will be held strictly confidential to the organizers and Consent Team unless you give explicit consent otherwise.

This form was adopted from Sarah Taub and Indigo Dawn’s Interfusion Festival form. Here is the Farm Block Consent Code of Conduct.

If you’ve been to Farm Block then you may know why we choose to host a music festival on our family farm. Farm Block is one of the primary fundraisers for The Dan Schmitt Gift of Music and Education Fund. This non-profit provides free instruments and lessons to youth in the Keweenaw and also after school creative empowerment programming in Kalamazoo.

Learn more

2239 N. Farmers Block Rd.
Allouez, MI 49805
hello@farmblock.com