Beach Permit Application

RYE PUBLIC SAFETY 555 Washington Road Rye, New Hampshire 03870

Kevin Walsh Mark Cotreau Police Chief Fire Chief (603) 964-5522 (603) 964-6411

BEACH PERMIT APPLICATION INSTRUCTIONS The Applicant must complete this form and return to the above address. You must include a valid Certificate of Insurance that includes the Town of Rye, its officials, employees and agents as additional insured on a primary and noncontributory basis for claims and liabilities arising from or related to the Applicant’s business operations.

APPLICANT INFORMATION Date of Application: ______Applicant: ______Phone: ______Street Address: ______Email: ______City/ Town: ______Zip: ______Contact Person: ______Phone: ______Person Duly Authorized to Sign this Application:______

ACTIVITY INFORMATION (attach sufficient information to describe lesson, rental or event activities) Type of Lessons and/or Equipment Rentals or Description of Event: ______Beach Location(s): ______Season From: To: Days: Su M Tu W Th F Sa Hours: Number of Students per Session Min.______Max.______Number of Students per CPR Qualified Instructor Max. ______Number of Event Participants Expected: ______Number of Spectators Expected: _____ COMPLIANCE WITH LAW Applicant shall comply with all applicable state and federal law, and all applicable Town ordinances, regulations, rules, procedures, and lawful directives of Town officials and employees. INSURANCE Applicant shall maintain during the period of this permit commercial general liability insurance applicable to its conducting business operations on, about or in relation to Town beaches and to the indemnification obligation set forth below in a minimum amount of $1,000,000 per occurrence and $2,000,000 aggregate, including the Town, its officials, employees and agents as additional insured on a primary and noncontributory basis. Applicant shall provide the Town proof of the required insurance and additional insured coverage. INDEMNIFICATION To the fullest extent permitted by law, Applicant shall protect, indemnify, save, defend and hold harmless the Town, including its officials, agents, volunteers and employees (“Indemnified Parties”), from and against any and all liabilities, obligations, claims, damages, penalties, causes of action, costs, interest and expenses, including but not limited to reasonable attorney and paralegal fees, which Indemnified Parties may become obligated or suffer by reason of any accident, bodily injury, illness, emotional distress, psychiatric injury, personal injury, death of person, economic loss, or loss of or damage to property, arising indirectly or directly from, under, out of, in connection with, or as a result of Applicant conducting business related activity on, about or in relation to Town beaches or any action or inaction of the Applicant, its agents, employees, contractors, subcontractors or customers, and even if caused in part by any negligence or misconduct of Indemnified Parties. LIABILITY WAIVERS/EXCUPATORY CONTRACTS Because of the safety and liability risks involved in ocean and beach athletic and recreational activities, Applicant agrees to condition lessons, camps, equipment rentals and equipment issuance on the customer’s (in the case of an adult) or the customer parent/legal guardian’s (in the case of a minor) execution of the Town of Rye’s Release and Waiver of Liability form, a copy of which is attached. Applicant, in light of variable statutes of limitation, shall retain these forms for 20 years or provide them to the Town. I certify, personally and on behalf of the Applicant, that the above information is correct under penalty of RSA 641:3, Unsworn Falsification, and agree, personally and on behalf of the Applicant, to all the terms and conditions in this Application and that any breach of the terms and conditions shall be cause for permit revocation. Print Name: ______Signature: ______(Duly Authorized)

Applicant: Please check items submitted  Valid Insurance Certificate-Town of Rye named as additional insured  Town of Rye Beach Permit Application (NOTARIZED)

STATE OF NEW HAMPSHIRE ROCKINGHAM, COUNTY. The person signing this Release and Indemnification, known to me or satisfactorily proven to be the same, appeared and signed it before me, and took oath that he/she signed it for the purposes intended and that he/she was duly authorized to sign the Release and Indemnification by the organization named herein.

Date:______, 20______Notary Public

My Commission Expires:

TOWN APPROVALS Police: ___ Fire: ___ Board of Selectmen: ___ Insurance Verified: ______Details: ______Conditions: ______Effective Date of Approval:______Permit Expires: ______TOWN OF RYE RELEASE AND WAIVER OF LIABILITY FOR BEACH PERMIT ACTIVITIES

Lesson, Rental or Event:______

Date of Lesson, Rental or Event: ______

Sponsor:______

Sponsor’s Address:______

In consideration for permission to take lessons, rent equipment or participate in the above event which will be held at beaches in the Town of Rye, for myself, my heirs, executors, administrators, legal representatives, assignees, and successors in interest, I hereby release the Town of Rye, its officers, employees and agents from any and all claims, actions, lawsuits, administrative proceedings, liability loss or damage, including but not limited to bodily injury, illness, death or property damage (i.e. claims) arising out of or in any way related to my participation in ______(Name of lessons, rental or event) and streets for the event or any acts or omissions whatsoever of the Town, its officers, employees and agents related to my participation in the said ______or to my use of beaches in the Town of (Name of lessons, rental or event) Rye for the event arising out of the negligence, fault, breach of warranty, products liability or strict liability of the Town, its officers, employees and agents or third parties, whether such negligence, fault breach of warranty, products liability or strict liability is sole, joint or several.

I also hereby agree to abide by all town requirements regarding beach use, including, but not limited to: 1) Obey all lawful orders of Beach Lifeguards, Police Officers or Fire Officers; 2) Not surf when beaches are closed to surfing by the Town of Rye due to weather/safety conditions; 3) Use a leash at all times; and 4) Stay at least 50 feet away from all swimmers and Lifeguard-protected swimming areas.

This release includes a release from any and all such claims which might be made by members of my immediate family or their heirs, executors, administrators, legal representatives, assignees and successor’s interest.

(Print) (Guardian signature required for minors) Participants Name Participant/Guardian Signature Date

______

This release form must be signed by all event participants, retained by the Beach Permit Applicant for a period of at least twenty years, and provided to the Town of Rye upon demand.