Permit Application

Camp Wyanokie Commission     APPLICATION   #_________

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 (   ),         Yeoman’s (   ),
Lion’s Den* (   ),         Campsite,         NE (   ),         South (   ),         East (   ),         West (   )

(   ) Special Permission Request(s) _______________________________________________

* Please note that priority is given to groups of 20 or more for use of the Lion’s 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 occurrence, bodily injury or/and property damage liability and should name  Camp Wyanokie as an additional insured.

Application approved (   ) USE PERMIT – CAMP WYANOKIE COMMISSION

BY ________________________________  DATE __________

FEE RECEIVED (   )   AMOUNT  ________________