Dingman Township

Recreation Commission

Field Use Application

Click Here to See Park Rules

 

Applicant                                                                       Contact Person

__________________________________                _________________________________

Address                                                                         Address

__________________________________                _________________________________

Phone                                                                            Phone

__________________________________                _________________________________

 

FIELD                                                DATES REQUESTED                                      TIMES

 

__________________            ____________to_____________                   ______ to ______

 

 

__________________            ____________to_____________                   ______ to ______

 

 

__________________            ____________to_____________                   ______ to ______

 

ACTIVITY                                                     # OF TWP RESIDENTS           # OF TEAMS

 

________________________________        ___________________            ______________

 

 

It is understood that the applicant shall:

 

A. Have at all times, while the permit is in effect, a general liability insurance policy with minimum limits of liability in the amount of $1,000,000 combined single limit for each occurrence and $1,000,000 combined single limit for general occurrence.

B. Provide a certificate of insurance with Dingman Township named as an additional insured.

C. Save, defend, keep harmless, and indemnify the Township and its appointed and elected officials, officers, servants, agents, and employees from and against any and all attorney fees, charges, liability or exposure, however caused, resulting from or arising out of or in any way connected with the applicant’s activities.

D. Upon request, provide a complete roster, with names and addresses, of all members of the applicant’s organization, and be kept current throughout the year.

E. Comply with all township rules, regulations, resolutions, and ordinances governing the use of the fields. A copy is attached.

 

Attest: _________________________                      Signature: ____________________________

 

_______________________________                                  _____________________________________

 Name and Title (Printed)                                                                 Name and Title (Printed)

Date:_________________