Permit Number

Division of State Parks, Department of Land and Natural Resources(to be filled out by DSP staff)

Special Use Permit

SUP-Group Use and Special Activities - O‘ahu* Fields that must be filledO‘ahu

Island:Date(s) of Event:*

Park:*Times:*(click pull down button to left)

Specific Location

from:

to:

Total Number of People at Event:*(area within park, if applicable)

Permittee (individual applicant or person applying for organization or company; name as shown on driver’s license or official identification):First Name*

Last Name*

Middle Initial

Mailing Address:*Email Address

CityPhone #:*Mobile: #(preferred, home, or other)

Emergency Contact:*

StateI Accept Texts:

Mobile Service Provider:(used only if needed)(AT&T, Verizon, T-Mobile, etc.)

Emergency Phone #:*(someone not going to theevent)

Zip Code

Emergency Mobile #:Organization or Company Name:

General Excise Tax Number(if applicable)(if applicable)

Description:

Type of Event (click one):
Describe event function or purpose. Examples:Group Use (over 25 people):
Family gathering/reunion
Birthday party Picnic gathering
Special Activities:
Volunteer/service projects
Research project
Educational activities/school excursions

Equipment or Provisions Used inConnection with Proposed Event:
Number and Types of Vehicles:*Additional Event Information and/orComments:
I certify that I have reviewed, understand, and agree to abide by all special conditions, standard conditions, and regulations attached to this permit
and that all information presented in this application, including any attachment(s), is accurate and correct to the best of my knowledge: andI shall have this permit with me while in the park and shall, upon request, show it to any law enforcement officer or authorized State Parks
representative:

Permittee Signature:*/s/Date:*(Please sign or type name above)(mm/dd/yyyy)

This application, when approved and issued by an authorized Department of Land and Natural Resources agent, shall serve as the official permit:
Special Conditions Included/Attached

Division of State Parks Approval:

Department or Board of Land andNatural Resources Approval:(if required)

Note:−No Special Conditions Attached/s/
Administrator/Assistant Administrator/Island SuperintendentApproval Date:/s/Approval Date:
Chairperson, Department of Land and Natural Resources

Submit original form a minimum of 45 days before your requested event to the respective State Park Office via email, fax, mail, or in person.

−All Division of State Parks offices will consider each application on its own merits.

−Permit approval will likely contain additional special conditions, reasonable limitation on the time or area and potential fees, for the reasonable public
use of the park that is consistent with management purposes.
Page 1 of 3 (Revised 3/5/2018)

General Rules, Conditions, and Prohibited Uses or Activities
Group Use and Special Activities Special Use Permit, Division of State Parks
General Rules and Special Conditions
Conditions and Rules•A general liability insurance certificate of insurance for a minimum of$1,000,000.00 per occurrence and $2,000,000.00 in the aggregate
naming the State of Hawaii, Department of Land and Natural
Resources, Division of State Parks as additional insured is requiredfor all inflatable “bounce houses” and may be required for othertypes of permit requests.

•Permit shall not be transferred or altered.

•Permittee and accompanying individuals shall abide by all
Department of Land and Natural Resources regulations andapplicable state and federal laws.

•Permit shall be revoked for violation of park rules, permit conditions,or any applicable law.

•Permit is not for exclusive use of park areas, unless specified in theapproved permit, and use of particular areas is on a first-come-firstserved basis. Note: Permit issued for an entire facility, such as apavilion permit, is for exclusive use of that facility. A group permit foruse of facilities does not allow exclusive use of a facility - it must beshared.

Standard Prohibited Uses or Activities
State Parks Rules Prohibit:•Organize and gather a group larger than 25 people withoutobtaining a group special use permit•Bringing pets or other animals into the park where posted signs saythey are prohibited, except for service animals performing theirservice duties. Where allowed, pets and animals must be crated,
caged, on a leash not to exceed 6 feet in length, or otherwise
physically controlled at all times. Horses prohibited unlessotherwise authorized.

•Operate, launch, or land unmanned aerial vehicle (drone) or othertypes of aircraft within the park.

•Smoke, including E-cigarettes, or use any tobacco products.

•Drink, display, or possess alcoholic beverages or illegal drugs.

•Build or light fires except in fireplaces and grills designated by State
Parks or dispose of live coals except in designated ash pits orreceptacles.

•Use or possess fireworks, firecrackers, explosives, firearms, andother weapons•

Obstruct or unreasonably interfere with other park users•

Gamble or conduct commercial activities, including advertising,sales, soliciting, begging, or collecting money except where permit
issued pursuant to Section 13-7, Hawaii Administrative Rules•Permittee shall be responsible for clean-up and restoration of allareas used, including cleaning up after pets.

•Permittee shall be liable for repair, replacement, or payment of any
damages to park property, including signs, devises, or features.

•The board or its authorized representative may require the applicant,at their own cost, to provide licensed security services andprotection in the interest of public safety and welfare and for theprotection of property - when the number of persons under thepermit is one hundred (100) or more or for other safety relatedreasons.

•Dispose of garbage, paper, trash or rubbish of any kind except inplaces designated for rubbish disposal (Permittee is required toremove rubbish from their event).

•Engage in nudity or disorderly conduct and use of obscene orobjectionable language

Permittee waives any and all claims he or she may have against theState of Hawaii and its respective officers, agents and employees,
and agrees to defend, hold harmless and indemnify the State ofHawaii and its respective officers, agents and employees, from any
suits, actions and claims arising out of or in any way connected withthe activities permitted under the permit.

•Drive or park vehicles on roads or areas not designated or
specifically provided for this purpose.

•

Use of skateboards where posted signs say there are prohibited•

Use metal detecting devices except on sand areas of beaches.

•Operate or use any audio device, electronic device, or musicalinstrument in such a manner as to create excessive noise or
nuisance unless specified in the approved permit.

•Operate or use any portable motor driven electric generating plant,
pump or compressor or any other equipment driven by a portableengine or motor except if specified and approved on a permit•

Destroy damage, dig, remove, or possess any tree, shrub, or otherplant, except where specifically permitted and then only gathered inreasonable quantities and for personal use.

•Destroy, disturb, graffiti or mutilate any geological feature•Take, excavate, destroy or alter any historic property or burial siteor any objects and materials from such properties or sites•Remove, possess, damage, disfigure, deface, or destroy any park
sign or device••

Where provisions of this permit conflict with State Parks Rules theSpecial Conditions shall prevail.

•This permit may be revoked if these conditions are not followed:[HAR §13-146-50(c)(6) Permits may be denied when:
The applicant has a prior record of noncompliance with permit
conditions or violations of this chapter][HAR §13-146-50(d)(3) Permits may be cancelled or terminated at
any time without advance notice when: Permittees violate permit
conditions or provisions of this chapter

Standard Precautions•

If no lifeguards are present near water - swimming, wading, and anyother water activities shall be at your own risk. Read and follow
guidance on all warning signs.

•Do not leave valuables unattended. Lock your vehicle.

•

Exercise good judgment while using the park. Security andemergency services are not provided.

•

In case of Emergency call 911. Cell phone coverage in area can belimited or non-existentNote: State Parks Administrative Rules, Chapter 13-146, is available at
http://dlnr.hawaii.gov/dsp/
VIOLATIONS: Report suspected park rule and law violations toenforcement officers. On all islands, call 643-DLNR (643-3567), noarea code required.

By clicking this box, I certify I have read and agree to abide by rules, conditions, and prohibitions listed above.

Clear All

Page 2 of 3 (Revised 3/5/2018)

Permit Number

Division of State Parks, Special Use Permit(to be filled out by DSP staff)

Special Use Permit Conditions(Addendum to Group Use and Special Activities Permit)

SUP-* Fields that must be filledO‘ahu

Island:Date(s) of Event:*Park:*Times:*(click pull down button to left)

Specific Location

from:

to:

Total Number of People at Event:*(area within park, if applicable)

Permittee (individual applicant or person applying for organization or company; name as shown on driver’s license or official identification):First Name*

Middle Initial

Last Name*

Email Address

Organization or Company Name:

General Excise Tax Number(if applicable)(if applicable)

Attachments:

Insurance Certificate:

Letter of Request:

Maps:

Supporting Documents

OtherAddendum PageNone

3ofPermittee Shall (for staff use only):

Page 3 of 3 (Revised 3/5/2018)4