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 priorily 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: $5.00 Registration fee per permit

plus $1.00 per person - per night

Day Usage: $5.00 Registration fee per permit

plus $1.00 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 name Camp Wyanokie as an additional insured.

Application approved ( ) USE PERMIT - CAMP WYANOKIE COMMISSION

BY ________________________________ DATE __________

FEE RECEIVED ( ) AMOUNT ________________