Pool Use Contract
Special Groups
The Newton Pool is happy to welcome your group to our facility. Our highest priority is the safety of our members, guests and staff, to that end the following guidelines must be followed while your group is at the pool. Any violation of these policies may result in the loss of pool privileges for your group. 1. Your agency must complete and return the Application for the Use of Town of Newton Park Facilities. (see attached) 2. Your agency must provide a ratio of 1 staff/adult: 10 children. These adult supervisors must be located within the fence of the pool and must be actively engaged in the supervision of the children. Additional parents are welcome but must adhere to the same rules as paid staff. 3. Staff/Adult supervisors are not allowed to use their cell phones, PDA’s or other electronic devices while supervising children at the pool. The only exception is in an emergency to call for emergency medical services. 4. The management and staff reserve the right to ask children to exit the pool if they are endangering themselves or other swimmers. 5. Buddy checks will be conducted every 30 minutes. Please make sure that all children are paired up into buddies prior to arrival at the Newton Pool. When the lifeguards blow the whistle twice, buddies must get together and hold hands high in the air. We will practice prior to going into the pool. 6. Any children who would like to use the slides must first complete a swim check. After completing a swim check, swimmers will be given a green wrist band indicating that they are capable of swimming in deep water. All other swimmers must remain in the shallow end or kiddie pool area. 7. The fee for the use of the pool is $3 per child. Adult staff/volunteers are free. In order to facilitate recordkeeping, this fee is payable by check only. The agency must supply a check for the full amount on the day of your visit. Your visit hours are 10am‐12pm. 8. The agency must provide Newton Town Pool with a list of all children attending the pool day. In addition, the agency must carry copies of signed permission slips for all children specifically noting a visit to the Newton Town Pool. 9. The agency must carry emergency medical and contact information for all participants. This information must be on the pool deck during your visit. 10. The organization shall keep in full force and effect the following insurance and provide to the Town of Newton prior to the use of facilities a certificate of insurance: 1. Comprehensive General Liability Coverage: Minimum Limits of $1,000,000 per occurrence/$2,000,000 General Aggregate. Coverage is to include Athletic Participation 2. Medical Payments: $10,000 3. Sexual Abuse and Molestation Coverage: Minimum Limit: $1,000,000 4. Non‐Owned and Hired Automobile Liability Coverage: Minimum Limit of $1,000,000 5. Workers Compensation: If applicable, NJ Statutory Benefits I certify that I have read and agree to abide by the aforementioned conditions. __________________________________________________________ _______________ Signature and Title of Certifying Officer Date: APPLICATION FOR THE USE OF TOWN OF NEWTON PARK FACILITIES Date: ________________________
Name of Organization: ___________________________________________________________________________
Address: _____________________________________________________________________________
Type of Organization: ____________________________________________________________________________
(Fraternal, Social, Education, etc.)
Name of person responsible for this use: ______________________________________________________________
Home number: ________________________________Work number: ______________________________________
Park requested: (
) Memory Park
(
) Pine Street Park
( ) Summit Avenue Park
Facility desired for: ______________________________________________________________________________
(Type of Activity)
Estimated no. of
people involved: Participants:__________________________ Spectators:___________________________________
Date(s) requested for use: _____________________________ Time: _______________________________________
Request use of:
( ) Shelter
( ) Utility Field
( ) Soccer Field
( ) Picnic Area
(
(
(
(
) Tot Lot
) Baseball Field
) Softball Field A
) Softball Field B
(
(
(
(
) Swimming Pool
) Little League Field
) Blacktop Area
) Other________________________________
Save Harmless Clause:
The Undersigned has read the rules and regulations of the Newton Recreation Commission pertaining to the use of Newton Park
Facilities, and agrees to abide by them. Undersigned further assumes all risks incident to its operation on said grounds and facilities
and agrees not to sue the Newton Recreation Commission or the Town of Newton for any injury to person or property occurring
during the use of the lands and premises of the Newton Recreation Commission on the Town of Newton. The undersigned further
agrees to indemnify the Newton Recreation Commission and the Town of Newton and save it harmless from any and all claim or
claims brought against it by or on behalf of any person, firm or corporation based upon any act or omission or any alleged negligence
of the undersigned. The Town of Newton is to be named as an additional insured to any insurance contract to which this application
applies. This Agreement is made in consideration of the issuance of a permit to the undersigned permitting its requested operations by
the undersigned on lands and premises of the Newton Recreation Commission, subject to all rules and regulations pertaining thereto.
Insurance:
The Organization shall keep in full force and effect the following insurance and provide to the Town of Newton prior to the use of
facilities a certificate of insurance:
1.
2.
3.
4.
5.
Comprehensive General Liability Coverage: Minimum Limits of $1,000,000 per occurrence/$2,000,000 General
Aggregate. Coverage is to include Athletic Participation
Medical Payments: $10,000
Sexual Abuse and Molestation Coverage; Minimum limit: $1,000,000
Non-Owned and Hired Automobile Liability Coverage: Minimum Limit of $1,000,000
Workers Compensation: If applicable, NJ statutory benefits
IN WITNESS WHEREOF, I have hereunto set my hand this
__________day of ______________, 20_______.
_________________________________________________________
(Legal Signature)
COMMENTS: _______________________________________________________________________________________________
____________________________________________________________________________________________________________
Permission is (granted) (denied) for the use of the facilities as indicated above.
______________
(Date)
__________________________________________
(Newton Recreation Commission)
TOWN OF NEWTON
RECREATION DEPARTMENT
RIDER TO APPLICATION FOR USE OF NEWTON PARKS
AND RECREATIONAL FACILITIES
The applicant understands that the Town of Newton assumes no responsibility for injury or damage to persons or
property related to any activities to be conducted at the Newton Park and Recreational Facilities. The applicant is
aware that the Town of Newton’s insurance does not apply to groups and their members using recreational
facilities, as evidenced by the signature which appears on the attached Application for the use of Newton Park
and Recreational Facilities.
At the conclusion of each activity for which permission to use park and recreational facilities has been granted to
this applicant, it shall notify the Newton Recreation Supervisor, in writing, of any repairs to any facilities that are
required.
____________________
Date
____________________________
Signature of Applicant
Action taken by Recreation Commission:
( ) Approved
______________________________
Recreation Supervisor
( ) Denied
_____________________
Date