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2. Please review:
   Rules and Orders Regulating the Use of the Ipswich Town Greens (PDF)
4. Section I
6. Requesting Organization
7. Date
   Date
9. Name of Applicant
11. Phone Number
12. Email Address
14. Physical Address
15. Mailing Address
17. City
18. State
19. Zip
21. Section II
23. Requested Facility / Specific Area(s)

    1. Center Green Hall Haskell Lawn
    2. North Green

    1. South Green
    2. Other Town Owned Location
25. Other Location Requesting
27. Date(s) Desired for Activity
    Date(s) Desired for Activity
28. Time of Activity
    Time of Activity Start Time

    —

    Time of Activity End Time
30. What time do you need to access the green?
    What time do you need to access the green?
31. What time will you exit the green?
    What time will you exit the green?
33. Nature & Proposed Use
35. Area of the Green
36. Access to paved area?

    1. Yes

    1. No
38. Number of Adults Attending
39. Number of Children Attending
40. Number of Teens Attending
42. Will refreshments be served?

    1. Yes

    1. No
43. Board of Health approval needed?

    1. Yes

    1. No
45. Will streets and/or sidewalks be blocked or closed?

    1. Yes

    1. No
46. BOS approval?

    1. Yes

    1. No
48. If Merchandise Is to Be Sold, Please Describe (Percentage Profit of Items to Be Negotiated)
50. Please Outline or Attach Your Clean-up Plan
52. Attach Plan
54. By signing this application, the person whose signature appears below signifies that he/she is personally, financially responsible for their group, will see that the greens are not misused, that groups have proper adult supervision, that properties are used in conformity with policies established by the Town of Ipswich, and that any damages and/or loss whatsoever as a result of the group’s use of properties will be compensated in full by the responsible person, upon demand.
    
    It is hereby understood by the responsible person signing this application that any town activities have absolute priority for use of any portion of the green, even if an outside group (e.g., the applicant) has requested the use of a portion of the green for several weeks. Any town activity whatsoever that may be subsequently scheduled shall have absolute priority for use of the greens.
    
    The Town of Ipswich disclaims liability for loss or damage to personal property or personal injury, and the applicant individually and on behalf of each member of his/her group agrees to release and hold harmless the Town of Ipswich officials and employees and not to sue any of the same for any such liability or loss.
    
    I hereby personally accept on behalf of the sponsoring organization all financial responsibility for any and all damages to equipment and/or greens and all resulting cost of any nature whatsoever.
56. Responsible Person Signature (Applicant)
58. Date
    Date
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66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

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