Fillable APPLICATION FOR FIELD TRIAL PERMIT

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APPLICATION FOR FIELD TRIAL PERMIT

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APPLICATION FOR FIELD TRIAL PERMIT
A perm
it to sponsor and operate a field trial in accordance with the Fish and Wildlife Laws of New Jersey and, in
compliance with the regulations as set up by the New Jersey Division of Fish and Wildlife, is requested by:
DATE: _________________________________________
NAME OF ORGANIZATION: _________________________________________________________________
NAME OF CONTACT PERSON: _______________________________________________________________
ADDRESS: _________________________________________________________________________________
TELEPHONE NUMBER (home) _____________________________ (work) _____________________________
EMAIL ADDRESS_________________________________ TRIAL DATES:_____________________________
LOCATION OF TRIAL: State Lands _____________ Other ______________
Property Known As: _______________________________________________
Nearest Town: ____________________________________________________
TYPE OF TRIAL: Field Trial ______________ Retrieving Trial _____________
Other (state what type) ________________________________
FACILITY NEEDED: Assunpink Conservation Center _________________________
(check off)
SPECIES OF
GAME TO BE USED: __________________________________________________
NUMBER OF GAME: ________________________________
NOTE: Game birds shot on WMA property must be properly tagged before being transported and disposed of
off site. Please specify number of tags you need to purchase ________ ($0.25 each)
TYPE OF DOG BEING USED IN THE TRIAL (check off)
_____ Sette
rs _____ Spaniels
_____ Poin
ters _____ Retrievers
_____ Oth
er (please state) __________________________________________________________
FEES: Application Fee $2.00 per application
DEPARTMENT OF ENVIRONMENTAL PROTECTION
PHILIP D. MURPHY NATURAL AND HISTORIC RESOURCES
Governor DIVISION OF FISH AND WILDLIFE
CATHERINE R. MCCABE
Commissioner
P.O. BOX 420; MAIL CODE: 501-03
TRENTON, NJ 08625-0420
SHEILA Y. OLIVER
Lt. Governor
TEL: (609) 292-2965; FAX: (609) 984-1414
VISIT OUR WEBSITE:
WWW.NJFISHANDWILDLIFE.COM
David M. Golden, Director
-over-
$50.00 per day
$100.00 per day
Application Fee Only
$.25 each
NOTE:
Trials on State WMAs
Trials Also Using State Facilities
Trials on Other Lands
Bird Transportation Tag Fee
FOR WILDLIFE MANAGEMENT AREAS ONLY
A
n application for the holding of a trial shall be made no later than January 1. An application for a fall trial shall be
made no later than August 1.
T
he prospective permittee shall maintain public liability and property damage insurance for the requested period of
use, with an insurance company recognized to do business in the State of New Jersey, in the amount of
$100,000/$300,000 personal liability and $50,000 property damage. A certificate for such coverage shall be
submitted with each permit application.
All persons shall use every precaution to prevent damage, destruction, or fire. The permittee shall be completely
responsible for any damage occurring in the location of and during the times of the trial being conducted. No permit
shall be issued to any organization or persons who have damaged or destroyed State lands or property and who have
failed to reimburse the State.
T
he organization or persons sponsoring the event shall be responsible for the removal of all litter, cleaning of
clubhouses including kitchen and bathroom facilities, removal of all trash from the wastebaskets, trash cans and
refrigerators in the clubhouse, cleaning of horse manure and dog manure in the areas surrounding the clubhouse
fence and parking areas. The permittee shall be billed by the State for any expenses necessary to clean the facilities
after the use by the permittee. No future permits shall be issued to any organization or person who has failed to
reimburse the State.
ALL PERMITTEES ARE REMINDED THAT THE USE OF ALCOHOLIC BEVERAGES IS
STRICTLY PROHIBITED ON STATE OWNED LANDS AND FAILURE TO ABIDE BY
THIS COULD RESULT IN PENALTIES AND THE LOSS OF FUTURE PERMITS.
T
he specified club or organization agrees to conform and abide by the rules and regulations concerning the issuance
of field trial permits as stated in Regulation 7:25-2, Use of All Lands and Water Areas Under the Control of the
Division of Fish and Wildlife for Field Trial Activities.
P
ERMIT FEE ENCLOSED: _______________________ BIRD TAG FEE ENCLOSED: ____________________
SIGNATURE OF APPLICANT: __________________________________________________________________
ATTACH YOUR INSURANCE POLICY TO THIS APPLICATION—DO NOT SEND SEPARATELY
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APPLICATION FOR FIELD TRIAL PERMIT

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Completed 13 May 2021

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