2024 Bayley Beach Application Form

This online form is ONLY for addresses in zip code 06853.

This form must be completed and the parking sticker received in order to park at Bayley Beach. YOUR EMAIL CONFIRMATION IS YOUR WALK-IN PASS. If you have a car registered in a state other than Connecticut, you must download the paper form and turn in proof of residency to the Sixth Taxing District. You can download the form HERE

Resident Name*

First NameLast Name

Spouse/Partner

First NameLast Name

Address - Bayley Beach Passes are only for residents who live in 06853*

Street Address

Street Address Line 2

CityState / Province

Zip Code - These passes are only for residents of 06853

List of people who reside full time at the above residence that are requesting walk in passes. You do not need to list any member below the age of 10.

Phone Number*

E-mail*

example@example.com

WALK-IN PASS*

AFTER YOU PAY, YOU WILL RECEIVE AN EMAIL CONFIRMATION. THAT EMAIL IS YOUR WALK-IN PASS

Vehicle #1

Connecticut Vehicle Plate Number Vehicle #1*

Vehicle Plate Numbers*

Only include Numbers, not the alpha characters

Registration Expiration Date Vehicle #1

Year of Vehicle #1:*

Make of Vehicle #1:*

Model of Vehicle #1:*

Vehicle #2

Connecticut Vehicle Plate Number Vehicle #2

Vehicle Plate Numbers*

Only include Numbers, not the alpha characters

Registration Expiration Date Vehicle #2

Year of Vehicle #2:

Make of Vehicle #2:

Model of Vehicle #2:

Vehicle #3

Connecticut Vehicle Plate Number Vehicle #3

Vehicle Plate Numbers*

Only include Numbers, not the alpha characters

Registration Expiration Date Vehicle #3

Year of Vehicle #3:

Make of Vehicle #3:

Model of Vehicle #3:

If you have more than 3 vehicles, please fill out a second form.

I agree with the following statements:

I understand that Parking Permit or Resident Card is required for entry into the beach parking lot. Parking permits must be adhered to the lower left hand corner of the vehicle’s windshield or to the driver’s side rear window.I understand that I will be charged $30 for each vehicle that I request a permitI understand that my beach sticker will be mailed to the address on this application.I understand that I will be assessed a late fee of $10 if I submit my application after June 14thI understand that my beach application could be rejected and my money refunded if I don’t not live in 06853 or submit illegal documents for proof of residency.I UNDERSTAND THAT MY EMAIL CONFIRMATION THAT INCLUDES THE NAMES OF ALL RESIDENTS OF MY HOUSEHOLD IS TO BE USED AS MY WALK IN PASS.

Date

Signature confirming that the information I submitted is correct.

My Products

Beach passPlease choose the number of beach passes you are purchasing.

$30.00 Quantity

Total

$0.00

Credit Card

2024 Bayley Beach Permit

Credit Card