††††††††††††††††††††††† Camp Wyanokie Commission†††† APPLICATION ††#_________

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CALDWELL / FAIRFIELD / NORTH CALDWELL / ROSELAND / WEST CALDWELL†††††††††††††††††††††††

†††††††††††† MUNICIPAL BUILDING, GOULD AVENUE, NORTH CALDWELL, NJ 07006

†††††††††††††††††††††† †††††††††††††††††††††††† (973) 228-6432 - fax # (973) 228-2914

††††††††††††††††††††††††††††††† ††††††††††††††††††††††††††† APPLICATION FOR USE

††††††† Individual/Organization Representative___________________________________________

††††††††† Organization(as appropriate)____________________________________________________

††††††††† Street Address ________________________________ Municipality ____________________

††††††††† Telephone (home) ______________________ (business)_____________________________

††††††††† Dates Requested:

††††††††† Arrival __________ M ____________ 20___†† Departure _________ M _____________ 20___

††††††††† Facilities Requested:

††††††††††††† Leanto #1 (†† ),†††††††† #2 (†† ),†††††††† #3 (†† ),†††††††#4 (†† ),†††††††† Troop 9 (†† ),†††††††† Yeomanís (†† )

††††††††††††† Lionís Den* (†† ),†††††††† Campsite,†††††††† NE (†† ),†††††††† South (†† ),†††††††† East (†† ),†††††††† West (†† )

††††††††††††† (†† ) Special Permission Request(s) _______________________________________________

††††††††††††††††† * Please note that priorily is given to groups of 20 or more for use of the

††††††††††††††††† Lionís Den. If not in use, it is available to any permit holder.

††††††††† Number of Persons: Youths _____________ Adults ____________

†††††††††††††††††

††††††††††† In connection with the filing of this application I hereby acknowledge that I have read the Rules and Regulations

governing use of Camp Wyanokie, and agree to abide by them.

††††††††

Additionally I, and all members of any group, agree to hold Camp Wyanokie harmless from any and all claims

for damages which might arise from the exercise of privileges granted for the use of Camp Wyanokie.

 

††††††††††††††† ††† _____________††††††††††††† _____________________________________

†† †††††††††††††††††Date††††††††††††††††† †††††††††††††† ††Signature

 

†††††††† ††††††††††††††††††††††††††††††††††††††††††††††††††† NON-RESIDENT APPLICANTS:

††††††††††††††††††††††† ††††††† Overnight Camping: $10.00 Registration fee per permit

†††††††††††††††††††††† †††††††††††††††††††††††† plus $5.00 per person - per night

††††††††

††††††††††††††††††† ††††††††††† Day Usage: $10.00 Registration fee per permit

†††††††††††††††††††††††††††††† †††††††††††††††† plus $5.00 per person

††††††††

†††††††††††††††††† NON-RESIDENT INDIVIDUALS & ALL ORGANIZATIONS:

INSURANCE REQUIREMENTS

††††††††

†† ††††††††††††††††††††††††††Hold Harmless Agreement

††††††††

†††††††††††††††††††††††††††† Certificate of Insurance

 

†††††††††††††††††† †††† †††††Tour Permit

 

†††† Your certificate of insurance must show a minimum limit of $500,000 per occurrance, bodily injury

††† or/and property damage liability and should nameCamp Wyanokie as an additional insured.

††††††††

†††††† Application approved (†† ) USE PERMIT - CAMP WYANOKIE COMMISSION

 

†††††††††††††††††††††††††††† †††††††††††††††††††††††††††††††††† BY ________________________________DATE __________

 

†††††††† FEE RECEIVED (†† )††††† †††††††††††††† ††AMOUNT________________

††††††††