Park & Field Use Application Applicant InformationName First M.I Last Drivers License Number Email Address Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age Day PhoneEvening PhoneCell PhoneFax Company/Organization Name Is this a company sponsored event? Company Phone #Web Address Company Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Alternate Contact Person Alternate Day Phone #Alternate's Cell PhoneResponsible PartyWill the applicant be in attendance at this event? Yes No Is the applicant the responsible party? Yes No If applicant is NOT the responsible party for this event, please complete the fields below. Otherwise, please go to General Event InformationResponsible Party's Name (on-site event supervisor) Drivers License # Age Email Address Responsible Party Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Day Phone #Evening PhoneCell PhoneFax # General Event InformationName of Event: Event Dates (include setup/clean up) Expected attendance per day Descirbe your event and activities in as much detail as possible including gamesHow many of the participants will be under the age of 21? If any how many adult supervisors will be in attendance? Event Date Time (include setup) Hours : Minutes AM PM AM/PM Event End Time (include cleanup) Hours : Minutes AM PM AM/PM Park Specific Area of Park Are you a 501(c)3 non-profit? Do you have commercial liability insurance? What are the limits? I understand and agree that by applying for this permit I am responsible for the conduct of the attendees. I have read the Borough's parks usage policy and understand and agree that I am responsible for any violation of the rules and condition of issuance of the permit by any attendee that such a violation may result in the immediate cancellation of this permit, once issued, by any public officer or police officer of the Borough of Oakmont. I agree to abide by the rules and certify that I, on behalf of the applicant or organization, am also authorized to commit that organization, and thereof agree to be financially responsible for any cost and fees that may be incurred by or on behalf of the event to the Borough of Oakmont. I also understand that acceptance of application should in no way be construed as a final approval/ confirmation of this request. Signature Please type your full name above to serve as your electronic signature. Company if applicable
