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2. Organization or Team Name*
4. Contact Name*
5. Alternate Contact Name
7. Contact Email*
8. Alternate Contact Email
10. Contact Phone*
11. Alternate Contact Phone
13. Organization or Contact Address*
    Street
15. City*
16. State*
17. Zip*
19. Field(s) Requested*
21. Field Requested For*
23. Day(s) of the Week*

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday

    1. Friday
    2. Saturday
    3. Sunday
25. Date(s) 1*
    Date(s) 1
26. Time 1*
    Time 1 Start Time

    —

    Time 1 End Time
28. Date(s) 2
    Date(s) 2 Start Date

    Date(s) 2 Start Time

    —

    Date(s) 2 End Date

    Date(s) 2 End Time

    Specifically for weekly requests

29. Time 2
    Time 2 Start Time

    —

    Time 2 End Time
31. Other Dates and Times as Needed
    Different than above
35. Insurance Requirements

    A Certificate of insurance must be submitted to the Department of Recreation prior to issuance of a permit. Your organization must carry at least $1,000,000 of liability and property damage insurance. This certificate must provide coverage on the dates of use and must name “Township of Cherry Hill” as additional insured.

    If you cannot supply one at this time, please submit a word document saying that one will be supplied before your schedule event(s). COI is required for any permits to be issued. 

37. Liability Insurance Upload*
39. General Requirements/Restrictions
    GENERAL REGULATIONS/RESTRICTIONS 1) Groups using the field will clear all trash, bottles and cans after each use; 2) Groups will adhere to all regulations specified in Park Ordinance 90-73 including no use of alcoholic beverages; 3) Groups shall not alter fields in any way; 4) Parking on fields or playground areas is strictly prohibited. Vehicles should use designated parking areas only. If on-street parking is the only available option, players will be mindful of neighboring homes. 5) The team hereby signifies that it will abide by the regulations of the Department of Recreation for use of facilities and that any infraction thereof may result in immediate cancellation of use. The team also assumes full liability for any damage to property. Participants assume all risk and hazards incidental to the conduct of the activities. The participants hereby release, absolve, indemnify and hold harmless, the Township of Cherry Hill. 6) EFFECTIVE 2013 – Smoking is prohibited on all Township properties.
41. FAILURE TO COMPLY WITH THE ABOVE INSURANCE REQUIREMENTS, REGULATIONS AND RESTRICTIONS WILL RESULT IN LOSS OF PERMIT.
43. Fees
    If applicable, all fees must be paid in full to Cherry Hill Township before any permit is issued.
47. THE UNDERSIGNED AUTHORIZED REPRESENTATIVE FOR THE ABOVE MENTIONED ORGANIZATION HEREBY CERTIFIES FULL UNDERSTANDING OF THE CHERRY HILL TOWNSHIP REGULATIONS AND ORDINANCES AND IS IN COMPLIANCE.
49. Authorized Representative Signature*
50. Date*
    mm/dd/yyyy
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52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field