*
Required
Please read the regulations below. By checking "yes," you agree to each regulation.
Name
First
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required
Middle
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required
Last
*
required
Address
Address 1
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required
Address 2
City
*
required
State
*
required
Zip
*
required
Phone (xxx) xxx-xxxx
Phone
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required
Email
*
required
The permit will be valid only on District-owned property at Town Line Road and Route 364 in the Town of Middlesex.*
Yes
No
All DEC regulations apply.*
Yes
No
Using the property is only permitted only on days when school is NOT in session. *
After 3PM DURING THE WEEK, you may use the property after school hours. (NO HUNTING OF ANY KIND)
Yes
No
All users are required to sign in and out of the property at the kiosk located in the parking area on Town Line Road.*
Yes
No
The permit is valid for use only by the permit holder.*
Yes
No
The permit must be displayed in your vehicle*
Yes
No
I am a District resident.*
Yes
No
No structures of any kind are to be erected anywhere on the property. The District reserves the right to remove any property at any time.*
Yes
No
The district is not responsible for any lost, stolen or damaged property of any kind.*
Yes
No
Any person(s) not following regulations will have permissions revoked.*
Yes
No
Permits expire on July 1, of each year.*
Yes
No
The District reserves the right to rescind a permit at any time.*
Yes
No
In order to process your application, you must provide the district with valid identification (Driver's License/Non-Driver ID).
Attach File
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required
Max file size: 10 MB
I have read and agree to comply with the regulations on the Marcus Whitman Outdoor Campus permitted on this application.
Signature
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required
Date
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required
(mm/dd/yyyy)
Please send a confirmation email to the address below*:
Please provide an email address where we can send a link to your current form.
Email Address :