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Step One

Disclaimer
Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.
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Step Two

General Use Park Permit
In order to ensure sufficient time to process your permit, please submit this form no less than ten business days prior and no more than six month in advance of your event or reservation date. Please allow up to 10 business days for processing and response.
Please also read the information contained within this web page on the fees, insurance and conditions associated with a park permit agreement before filling out and signing this form.
*All government training must include a Certificate of Insurance.
Company or Group Name*
Company or Group Website
Name(s) of Park(s)*
Specific Area Within Park Requested
Detailed Description of Onsite Activities*
If requesting parks not listed above, please specify here.
Maximum Number of Participants*
Maximum Number of Vehicles*
Single-day or Annual*
1. Single Day
2. Annual
Date Requested
Date Requested
If requesting a specific date
Time Requested*
Time Requested Start Time
—
Time Requested End Time
First Name*
Contact Info. of Event Organizer
Last Name*
Address*
Address Line 2
City*
State*
Zip Code*
Country*
Phone Number - Primary*
Phone Number - Other
Email Address*
Will your activity impact adjacent public right-of-way, private properties, or surrounding landowners or businesses?*
Will a fee be collected?*
If so, how much is the participant fee?
Type of Organization*
Are you an insured government agency?*
Will activity be publicized on radio, TV, website, in newspapers or posted in public places?*
Certificate of Insurance
Please upload your Certificate of Insurance. Jefferson County must be added as an additional insured to general liability policies. Certificate Holder must be:
Jefferson County, Colorado
c/o IMA Certificate Compliance
1705 17th Street, Suite 200
Denver, CO 80202
Minimum requirements for Commercial General Liability $1M each occurrence $2M general aggregate $1M personal injury
Park maps or areas requested
Other useful information
Attachment 4
Signature of Applicant*
I (we) hereby swear or affirm, under penalty of perjury, that the information given here is true and correct. The typed signature below indicates this individual, or the legal entity the individual represents (as applicable), accepts responsibility for the activity and agrees to the terms and conditions of this agreement.
Date*
Date
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Step Three

Receive a Copy of Your Submission
By checking the box below, you will receive a copy of the application you are submitting; however, this does not mean that your application has been approved. We will contact you within 10 business days to let you know the status of your application.

Leave This Blank:

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

This field is not part of the form submission.
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JCOS - General Use Park Permit Application

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