Form Center

2. This form is not a permit. Please read this application in full. Completion of this application does not constitute an automatic approval and does not guarantee that a permit will be issued. Applicants are encouraged to include maps, plans and any pertinent supporting documentation with this application. Permitting questions can be directed to the Town’s Events Coordinator at 508-325-4166.
4. APPLICANT INFORMATION - REQUIRED
6. First Name of Primary Contact*
7. Last Name of Primary Contact*
9. Company/Organization of Primary Contact (If Applicable)
   i.e. Business Name
10. Street Address *
12. Town/City*
13. State*
14. Zip*
16. Email Address*
17. Phone Number*
18. Cell Phone
20. On-site Contact*
    if different than Primary Contact
21. Cell Phone for On-site Contact*
23. Are you established as a business ?*

    1. YES

    1. NO
25. A Town of Nantucket business certificate is required.
    Business Certificate

    If you are doing business on Nantucket, under anything other than your own name, you are required by Massachusetts General Law (MGL) to file a Doing Business As (DBA) with the Town Clerk’s Office. Some exceptions apply.
27. Does your business carry liability insurance?*

    1. YES

    1. NO
28. Are you offering this program anywhere else ?*

    1. YES

    1. NO
30. PROGRAM OVERVIEW - REQUIRED
32. Program / Course Name:*
34. Program Description *
36. Participant Outcomes (What are the benefits of taking this program / class ? What will be learned?)
38. Program Outline*
40. Requested Location of Program*
42. Start Date*
    Start Date
43. End Date*
    End Date
44. Class Days*

    1. Saturday
    2. Sunday
    3. Monday
    4. Tuesday
    5. Wednesday
    6. Thursday
    7. Friday
45. Target Population*

    1. Youth: Preschool
    2. Youth: School Aged
    3. Adult
    4. Senior
47. Cost:
48. 1. Per Participant
    2. Per Session
49. Other:
51. Class Start Time*
52. Class End Time*
53. Lengh of Session*
54. Min/Max Participants*
56. No exercise classes are to take place at Nobadeer Beach between the hours of 10:00am and 5:30pm. Two hour maximum block of time for the class / program.
58. Please list previous experience in providing this type of class or program:*
60. List instructor's qualifications, trainings, including required or preferred certifications.
62. Required Equipment & Supplies.*
    List all equipment and supplies required to conduct the program and who will provide them. Please note: Participant Provided Equipment/Supplies and Instructor/Contractor Provided Equipment/Supplies.
64. Outline any safety and/or emergency considerations and steps you will take to mitigate any potential hazards or harm to participants.*
    Instructor will be responsible for informing the Town of Nantucket and participants of these potential considerations prior to any participation in activities
66. List any actions you will take in the event of inclement weather.
68. You may use this feature to upload a supporting document.
96. HOLD HARMLESS AGREEMENT
    In consideration of permission to use the public property, facility or services described herein, the Applicant agrees to save and hold the Town of Nantucket, its agents, servants, and employees harmless from any and all liabilities or costs arising out of the use of the described premises by the Applicant, the Applicant's guests, employees, subcontractors, and/or other persons. The Applicant acknowledges that the permission to utilize the facilities is limited to the portion of the premises herein described (if applicable), and that the permission is valid only for the activity herein described. Notwithstanding the foregoing, this Hold Harmless Agreement shall be applicable to any claim asserted against the Town of Nantucket, its agents, servants, and employees, and for any loss incurred arising out of the Applicant's activity whether or not such claim or loss extends beyond the permitted type or locale of activity or occurs on a different date than specified. Commercial General Liability is required in the amount of $1,000,000 CSL (combined single limit) with the Town and County of Nantucket added as an additional insured.
98. SIGNATURE OF APPLICANT*
    By typing your name in the applicant signature field(s), and submitting this form electronically (via email), you affirm that all information contained within this document was completed truthfully, and to the best of your knowledge and you understand that your electronic signature is considered legally binding the same as signing your physical signature by hand.
Leave This Blank:


100. 1. Receive an email copy of this form.
101. Email address

     This field is not part of the form submission.

102. Submit Submit and Print

* indicates a required field