REV. 6/23/17 PERMIT #
SOUTH BRUNSWICK TOWNSHIP DEPARTMENT OF PARKS AND RECREATION
Municipal Building, P.O. Box 190, Monmouth Junction, N.J.
08852
OFFICE #: (732) 329-4000, x7671 FAX #: (732)
821-2811
INDOOR / OUTDOOR FACILITY APPLICATION AND USER
PERMIT
TO APPLY FOR A FACILITY PERMIT: A $25.00 NON-REFUNDABLE APPLICATION FEE IS REQUIRED FOR ALL FACILITIES (EXCEPT ATHLETIC FIELDS
)
AND WILL BE CREDITED TO YOUR FINAL RENTAL / PERMIT FEE. ATTACH CHECK OR MONEY ORDER TO COMPLETED APPLICATION
.
1. Application should be submitted no less than 30 days before the date of the event
with a non-refundable application fee of $25.
2. Insurance must be submitted within 10 business days of application.
3. Permits must be paid in full within 10 business days of approval or date will be forfeited..
4. Checks are payable to 'South Brunswick Township'.
5. Approved permits must be with the person in charge at the event.
6. There are no rain dates and no refunds for inclement weather. You
may reapply in same calendar year.
7. Refer to facility rules and regulations on reverse side of permit or our website
www.sbtnj.net.
D
a
t
e
of
a
pp
lica
t
i
on: Rec’d: ---------------------------------------------
EVENT DAY(S): SUN MON TUES WED THURS FRI SAT EVENT
DATE(S):
__________________________
PARK
OR FACILITY
REQUESTED: ______________________________________________________________________________________
Type
of facility requested (i.e., softball field, picnic area, etc.): #
needed:___________
(Include
set up and clean up time.) Start /Arrival Time: am/pm End/Leave Time: am / pm
Type of event: Will admission or donation be charged? Yes No
Expected
#
attending
activity:
Are
51% or more
attending
So.
Brunswick
residents?
YES
NO
#
Residents:
#
Non-Residents: _ ___
Equipment
or
special
needs:
#
Tables
#
Chairs
_
Other
__________________________________________________________
Person in Charge: Non-Profit Group? YES NO
Organization:____________________________
Address:
_______ Town: Zip:_________________
Phone
(BEST
#
TO
BE
REACHED
AT):
______
Email
address:____________________________________________
Alcohol Permit Requested: YES NO If approved by Rec. & Risk Mgt., a separate alcohol application form must be filed in the S. B. Township Clerk's office.
Entertainment or Amusements planned? YES NO (i.e. DJ, band, rides, amusements, bounce rides).Rides/amusements are subject to approval and
insurance requirements & must have a current Carnival & Amusement Ride Safety Permit to Operate from the NJ Dept. of Community Affairs of Codes & Standards
(
609
-
292
-
2097
)
, o
r
iginal permit must be posted conspicuously.
D
es
crib
e
t
ype
p
la
nn
ed: ____ _________________________
INSURANCE / USE OF PREMISES
AGREEMENT/
HOLD HARMLESS STATEMENT
A hold harmless statement is required for all events indemnifying South Brunswick Township. A certificate of insurance for certain type of events and facilities, and events
in which alcohol is served is required. Questions regarding insurance contact the Risk Management Department at 732-329-4000, x7671.
I/WE, THE ABOVE LISTED APPLICANT(s) indemnify and hold harmless the Township of South Brunswick and assume the risks of all conditions existing in the area
covered by this permit and shall assume liability for loss, damage or injury sustained by any person in attendance by reason of negligence of the person. I/We agree and
understand that as applicants, we may not apply for the use of these premises on behalf of another person or organization, or sublet Township premises to another
person or organization. We agree to abide by the rules and regulations outlined on the reverse side of this permit, and by the ordinances of the Township of South
Brunswick. We also agree that while we use the facilities made available by the Township of South Brunswick, that we will not discriminate on the basis of race, color,
religion, sex, natural origin, age, marital or veteran status, medical condition or disability. In consideration granted by the Township of South Brunswick for the use of
premises on this permit, the applicant does hereby covenant and agree to save and hold harmless the Township of South Brunswick, its elected and appointed officials,
as well as all employees while acting within the scope of their duties, from any and all liabilities or costs arising out of the use of the described premises by the applicant,
the applicant's invitees, or other persons. It is agreed that the use of the facilities on the above named day and date(s) will be used for the named purpose and no other.
Applicant acknowledges that the permission to use the above listed facilities is limited to those premises described and only for the activity listed. Notwithstanding the
foregoing, however, this agreement shall be applicable to any claim or claims asserted against the Township of South Brunswick or any loss incurred arising out of the
applicant's use thereof, whether or not said activity extends beyond the permitted type or locale, or occurs on a different date than specified. Applicant agrees that this
indemnification and hold harmless agreement shall include the responsibility to provide legal defense for the Township of South Brunswick for any suit arising out of the
applicant's use of the premises, and that should the applicant or applicant's insurance carrier fail or refuse to provide such a defense, the applicant will reimburse the
Township of South Brunswick for any and all costs incurred by it for any person or organization acting on its behalf
.
Sign
at
ure
of
a
pp
lic
ant
______________________________________________
Witn
ess ____________________________________________
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY
ALCOHOL PERMIT REQUESTED:
YES NO
Total
Amount
Due
:
________________
Application fee: ________________ Receipt # ________ Date: ___ Check #
Cash Amount
___
Balance Due: Receipt # ________ Date: ___ Check #
Cash Amount
___
Insurance Risk Mgt Dept:
Facility
Use: Approved
Denied
Date_ _____ __
Alcohol Use:
Approved
Denied
Date_ _ ______
Amusements:
Approved
Denied
Date_ _____ __
Approved by: __________________________________________________ Date Approved: _____________________________
AM
PM
AM
PM
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