Page 1 of 3
Application for Entertainment Permit
TOWN OF MILTON
43 Bombardier Road, Milton, Vermont 05468
www.miltonvt.org/recreation
Contact: Milton Recreation Department 802-893-4922
Application must be submitted to the Town of Milton at least 21 days prior to the event with all sections completed.
(The Town requires 48 hours notice if you cancel an event)
Applicant and Event Information
Applicant:____________________________________ DBA:___________________________________________
Address:_____________________________________________________Town/City:_______________________
Daytime Contact Numbers:______________________ Email Address:___________________________________
Type of Event:________________________________________________________________________________
Event Address:_____________________________________________________________________
Property Owner/Agent Signature:____________________________________________ Date:_______________
If a One Time Event: Date:____________________________ Hours: from _______________ to ___________
(If a re-occurring event, attach a detailed schedule of events)
If a One Time Event and you are requesting a Rain Date (provide date) _____________________
Attendance: ___________
Is the event Public Private
Will money be received? ___________
(Number of persons estimated) (Through ticket sales, entrance fee, solicitation, etc)
Description of Entertainment:_____________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Updated 08/31/17
click to sign
signature
click to edit
Page 2 of 3
Only the Authorized Applicant/Representative may cancel the event (48 hours notice is required) as noted
herein and no refund or any portion thereof will be made. Entertainment Permits are determined on a first come,
first served basis.
Any services and/or requirements of the Town will be at the expense of the Applicant; Town Staff will provide
an estimate of those costs to the Applicant prior to the event. The Applicant will be expected to provide payment
for any such services as required by the Town of Milton in advance of the event.
Applicant shall not allow or engage in any illegal activity and any damage to private or public property will be
the sole liability of the responsible person/agent/heirs/executors signing this Agreement,
The Town, its officers, agents and employees shall have the right to enter onto the property of the event to
confirm the Applicant's conformance to this Application and if a breach is determined, the Town shall have the
right to immediately terminate this Application and your permit for entertainment prior to the conclusion of the
event without refund.
Any and all risk management requirements are the sole responsibility of the Applicant and/or Property Owner or
Agent. Both the Applicant and the Property Owner/Agent must complete and sign the attached Liability Hold
Harmless Agreement.
The Applicant will be notified as soon as possible of the action taken with regard to approval or rejection of this Application.
As the authorized Applicant/Representative of this Application, I fully understand the requirements as
noted herein and further understand that it is my responsibility to read these documents and to be
cognizant of their content.
PRINT NAME____________________________________________
SIGNATURE:____________________________________________ DATE:___________________
Liability and Hold-Harmless Agreement
In consideration of the permit from the Town of Milton to engage my company and me to perform certain services
__________________________ (Company name) and _______________________( Property Owner/Agent) and I
agree, and for myself/ourselves and my/our heirs, executors and administrators agree to indemnify, defend, and hold
forever harmless the Town of Milton and its officers, agents and employees from and against any and all claims,
demands, liability, actions, judgments, settlements, damages, costs and expenses (including attorney’s fees and
disbursements) for injury to or death of any person, including myself, or damage to property arising out of or
resulting from any material, product, equipment, vehicle or service supplied by the company or by me, or the agents,
servants, or employees of either, or from any action or failure to act on the part of myself or the company or the
agents, servants of employees of either, while performing services for, at the behest of, under contract with or permit
from or on the premises of the Town of Milton.
Property Owner/Agent: ________________________________________________ Date:_______________
Print Sign
Applicant: ___________________________________________________________ Date:_______________
Print Sign
click to sign
signature
click to edit
OFFICE USE ONLY
Recreation: Event request reviewed by:_______________ Date: _______ Approved: _____ Denied: ______ ( see below)
Describe:______________________________________________________________________________________________
Police Needed: _____yes, _____no Signed:_________________________________________ Date:__________________
Describe:______________________________________________________________________________________________
Highway Needed: _____yes, _____ no. Signed:_________________________________________ Date:__________________
Describe:______________________________________________________________________________________________
Fire Needed: _____yes, _____ no. Signed:_________________________________________ Date:__________________
Describe:______________________________________________________________________________________________
Rescue Needed: _____yes, _____ no. Signed:_________________________________________ Date:__________________
Describe:______________________________________________________________________________________________
Health/Zoning: _____yes, _____ no. Signed:_________________________________________ Date:__________________
Describe: ______________________________________________________________________________________________
Any Comments/Conditions:
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Town Manager Approval
Entertainment Permit Fee $_______ Other applicable fee(s) $___________________________
Fee Amount Received $_______ Verified by: ______________________ Date:_____________
Approved by: _____________________________________________Town Manager Date:______________
Date Selectboard scheduled to consider:_________________________________________________
Date Selectboard took action and action taken:____________________________________________
Page 3
of 3