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2. First Name
3. Last Name
5. Address
7. City
8. State
9. Zip Code
11. Email
12. Phone Number
    (###) ### - ####
14. Website
16. Dates Requested
    Dates Requested Start Date

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    Dates Requested End Date
17. GPS Coordinates of Geocache
19. Physical Location/Directions to Geocache
21. The Fine Print
    By submitting this request I agree to the following:
    1. The Permittee, also known as geocache owner, has read and hereby agrees to comply with the requirements and instructions for geocache placement.
    2. The geocache has been viewed personally by Parks and Recreation staff and is acceptable as to size, contents, and location.
    3. Any rights granted or implied under this permit are non-exclusive and Parks reserves the right to issue other permits simultaneously with this permit on any lands under control of Anacortes Parks and Recreation Department. However, this permit may not be assigned by the Permittee to any other party.
    4. The geocache owner hereby agrees to hold harmless, defend and indemnify City of Anacortes, Anacortes Parks and Recreation, its employees, agents and assigns, from and against all claims, suits or actions arising from the placement, movement or removal of the geocache, or resulting from the contents of the geocache, or the use or misuse of said contents.
    5. Any equipment, and/or materials belonging to the geocache owner remaining on park premises 10 days subsequent to permit expiration, revocation and/or termination of this permit for any reason whatsoever shall then automatically become the property of Anacortes Parks and Recreation Department at no cost to the City of Anacortes.
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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