Special Use Permit Application
Please use this form to submit a Special Use Permit application. For inquiries, please contact us at info@ncprd.org. Applications must be submitted no less than 60 days prior to the proposed event or activity. A non-refundable application and processing fee will apply. Additional fees will be assessed based on the specific nature and requirements of the event.
Applicant's Information
Applicant Name (If applicant is a business/organization, please put the name of the business/organization.)
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Primary Contact Person (if different than applicant)
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First Name
Last Name
Physical Street Address (No P.O. Boxes)
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
On-Site Emergency Contact Information
Emergency Contact Name (Must be physically present on-site for the duration of the event)
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First Name
Last Name
Emergency Contact Phone Number (Must be available and reachable for the duration of the event)
Please enter a valid phone number.
Format: (000) 000-0000.
Event Details
Type of Special Use Requested
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Walk/Run/Bike Event
Youth Camp
Concert/Live Music
Photography/Filming
Scientific Collection
For Profit Event
Free Public Event
Fundraising Event
Other
Event/Activity Name
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Purpose of Event/Activity (Provide as much detail as possible)
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Proposed Date(s)
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Proposed Location (If the event location is within the City of Milwaukie, a City permit will be required in addition to the NCPRD permit.) Select all that apply.
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Alma Myra Park
Altamont Park
Ann-Toni Schreiber Park
Ardenwald Park
Balfour Park
Ball-Michel Park
Boardman Wetlands Nature Park
Bowman-Brae Park
Bunnell Park
Century Park
Concord Park
Dogwood Park
Ella V. Osterman Park
Furnberg Park
Harmony Road Neighborhood Park
Hawthorne Park
Heddie Notz Park
Homewood Park
Kronberg Park
Luther Road Property
Mill Park
Milwaukie Bay Park
North Clackamas Park
Pfeifer Park
Pioneer Park
Risley Park
Rivervilla Park
Scott Park
Sieben Park
Spring Park
Stanley Park
Springfield Family Park
Summerfield Park
Trillium Creek Park
Trolley Trail
Water Tower Park
Have you submitted an event permit application with the City of Milwaukie for this request? If one or more of the locations you selected is a City of Milwaukie owned (NCPRD managed) site. A City permit will be required in addition to the NCPRD permit. If approved by the City, a copy of the city permit must be sent to info@ncprd.org in advance of your event/activity.
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Yes
No
Please specify which sections of the Trolley Trail
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Active Event Hours: Please indicate the specific time your guests are scheduled to arrive and depart. (This should exclude your reserved setup and cleanup time).
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Desired Permit Start Time (Access to the space is not granted before this time)
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Hour Minutes
AM
PM
AM/PM Option
Desired Permit End Time (This is the time by which all guests, vendors, and equipment must be off-site. Please ensure your teardown and cleanup time is factored in.)
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Hour Minutes
AM
PM
AM/PM Option
Is this a One-Time Event or Recurring Event
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One-Time Event
Recurring Event
Attendance at Last Event (If this is the first event in the series of recurring events, enter "0").
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Estimated Attendance for Event/Activity
*
Details of Special Use Permit
Which of the following items will be present at your event? (Select all that apply)
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Tents (staking into ground is strictly prohibited)
Temporary Stage(s) or Platform(s)
Portable Restrooms (required to be ordered through NCPRD)
Temporary Fencing/Gates
Vendor Booths
None of the Above
Other
Upload a Site Map with specific locations of items that will be present at event
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Browse Files
Drag and drop files here
Choose a file
Cancel
of
Route Map Required for all walk/run/bike events (Your Route Map must list all parks/trails in your proposed route, location of all signage and route markers, location of all certified flaggers, course marshals and/or volunteers)
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Browse Files
Drag and drop files here
Choose a file
Cancel
of
Will this be a public event/activity? (While a Special Use Permit grants permission to utilize an NCPRD site for a designated purpose, the site will remain open and accessible to the general public)
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Yes
No
Will participants be charged a fee to attend this event?
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Yes
No
Will this special use require the presence of NCPRD staff?
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Yes
No
Provide a detailed explanation for the requested staff presence.
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Will this event require the closure of any public street(s), or require the use of sidewalks or other public rights-of way?
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Yes
No
Provide a detailed explanation for the closure, specifying the exact location(s) and affected areas.
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Will food be served to/prepared for event participants? A Food Handler’s Card is required for all individuals handling food, except for pre-packaged items.
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Yes
No
Will alcohol be served or sold? (An OLCC license, additional insurance, and a completed Alcohol Addendum form will all be required. )
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Yes
No
Will there be amplified sound or live entertainment? (In accordance with the local sound ordinance, noise levels at the park's boundary must not exceed 60 decibels. )
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Yes
No
Please explain what amplified noise or live entertainment will be at your event/activity.
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Will there be any filming or photography?
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Yes
No
Please explain what filming or photography will be at your event/activity.
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Will there be a need for additional restrooms? (Restrooms may be required for larger events. All additional restrooms must be ordered through NCPRD and paid in full no later than 15 business days prior to the event.)
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Yes
No
Will there be security at this event?
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Yes
No
Please explain what security will be at your event.
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Will participants engage in scientific collection or research? (Collected data is required to be shared with NCPRD's Natural Resource staff. )
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Yes
No
Does this request include something that will be placed in a site and not removed at the end of the permit? (Item must receive prior approval from NCPRD.)
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Yes
No
Please describe the item being placed on site, and the proposed location
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Is this event in partnership with NCPRD
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Yes
No
Please explain the partnership on this event/activity
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Is there anything else you'd like us to know about your proposed event/activity?
*
Acknowledgments
Applicant is responsible for obtaining all additional permits, licenses, and insurance certificates required upon the issuance of this special use permit. By signing below, the applicant acknowledges that you have read and agree to these terms and the conditions issued in conjunction with the Special Use Permit.
Clean Up Acknowledgement: By selecting "yes", applicant agrees to promptly clean up all paper or debris caused by applicant’s use of the area and understands that if such cleanup is not promptly undertaken the District reserves the right to do the cleaning itself and to charge the applicant for the actual time and expense incurred. The District reserves the right to deny future Special Use Permit applications should applicant not fulfill all conditions of this permit application.
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Yes
No
Insurance Acknowledgement: By selecting "yes", applicant agrees to provide a policy of liability insurance. This insurance shall provide coverage for not less than $1,000,000 for personal injury to each person, $1,000,000 for each occurrence involving property damage; or a single limit policy of not less than $2,000,000 covering all claims per occurrence. The limits of the insurance shall be subject to statutory changes as to maximum limits of liability imposed on municipalities of the State of Oregon. This insurance shall be without prejudice to coverage otherwise existing and shall name as additional insured Clackamas County and North Clackamas Parks and Recreation District and its officers, agents, and employees. The sponsor agrees to maintain continuous coverage for the duration of the permit. If the activity/event is located within the City of Milwaukie, you will be required to add the City of Milwaukie and its officers, agents, and employees as additional insured.
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Yes
No
Indemnity Acknowledgement: By selecting "yes", applicant agrees to defend, indemnify and hold NCPRD and if applicable, the city of Milwaukie, harmless from and against all claims, losses, and liability arising out of personal injuries, including death, and damage to property which are caused by applicant, or arising out of or in any way connected with the activities conducted pursuant to this application.
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Yes
No
City Codes & Permits Acknowledgment: By selecting "yes", applicant agrees to obtain all District, City and County permits and licenses that may be required, and shall comply with all laws and other conditions deemed necessary, including NCPRD Park Rules.
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Yes
No
Conduct & Nuisances Acknowledgment: By selecting "yes", applicant understands that if an outdoor activity is conducted in such a way as to create a nuisance for any business or resident of the area, future permits may be denied for that reason alone. Applicant will be notified as soon as practical that the
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Yes
No
Signature for General Acknowledgement
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Indemnification Agreement
By signing below, you acknowledge and agree as follows: In consideration of the District’s approval of this application for a special use permit, applicant accepts responsibility for the event and agrees to indemnify, defend and hold harmless North Clackamas Parks and Recreation District (NCPRD), and if necessary the City of Milwaukie, its officials, employees, agents, volunteers, and assigns from and against any and all claims, suits, liabilities and expenses (including but not limited to, damages, attorney fees, and costs) that may be asserted against the District arising out of or in any way related to the special use for which permission is sought. Applicant acknowledges that they have carefully read the foregoing application and understands its contents. Applicant affirms that they are authorized to sign this document and do so freely and without reservation.
Signature for Indemnification Agreement
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