Special Event Permit Application Form - Claremont Parks And Recreation Department
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2CLAREMONT PARKS & RECREATION DEPT.
Special Event Permit Application
152 South Street, Claremont, NH 03743
Telephone: (603)542-7019
APPLICANT AND SPONSORING ORGANIZATION INFORMATION
Please complete all data as required.
NAME OF ORGANIZATION:______________________________________________________________________________________________
APPLICANT NAME:______________________________________________________________________________________________________
ADDRESS:____________________________________________ CITY:_______________________________STATE:________ZIP:___________
DAYTIME PHONE: (____)_____________________ EVE. PHONE: (____)_____________________
E-MAIL:____________________________________________
MANAGER ON SITE DAY OF EVENT:_____________________________________ CELL: (_____)___________________________________
HOME PHONE: (_____)__________________________________
*Any change to the above information, please notify the Parks & Recreation Department immediately.
SPECIAL EVENT INFORMATION
Complete all data as required for event of any size.
Type of Event:
____ RUN/WALK
____RALLY
____PARADE
___ WEDDING CEREMONY/PHOTOS
____FAIR
____ CONCERT
____ PICNIC
____BIRTHDAY ___ OTHER (specify):_____________________________________________
EVENT TITLE:__________________________________________________________________________________________________________
EVENT DATE:___________________________________________ ESTIMATED ATTENDANCE:_____________________________________
TYPE OF FIELD/FACILITY REQUESTED: (please circle)
FOOTBALL / SOFTBALL / BASEBALL / SOCCER / HORSE SHOE PITS /
OPEN GREEN SPACE / PICNIC / PLAYGROUND / MOODY PAVILION /
TENNIS COURTS / BASKETBALL COURTS / TRACK
BARNES PARK / VET’S PARK / MOODY PARK / ARROWHEAD REC.
SPECIFIC SITE REQUESTED: (please circle)
AREA / MONADNOCK PARK / BROAD ST. PARK / RIVERSIDE SKATE
PARK / VISITOR CENTER GREEN
ACTUAL HOURS OF EVENT: _________________AM/PM to ___________________ AM/PM
SET UP TIME: ______AM/PM
TAKE DOWN TIME: ______AM/PM
DESCRIPTION OF EVENT AND SET UP AND CLEAN UP PLAN: _______________________________________________________________
________________________________________________________________________________________________________________________
*Please attach additional sheets as necessary, including plans, drawings, maps, etc.
PLEASE INDICATE WHETHER THE FOLLOWING ITEMS PERTAIN TO YOUR EVENT.
YES
NO
___
___
WILL THERE BE FOOD CONCESSION AND/OR FOOD PREPARATION AREA (S)?
(If you need to cook food in the event area) Please specify method: GAS / ELECTRIC / CHARCOAL / OTHER: ____________
___
___
WILL ALCOHOL BE SERVED? If yes, please see Alcohol Guidelines on the back page.
___
___
WILL YOU NEED A FIRST AID FACILITY? EMT? / POLICE? / FIRE?
Wednesday, January 13, 2016
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