Model Aircrafts & Model Rockets - Monmouth County

DORBROOK RECREATION AREAMODEL AIRCRAFT AND MODEL ROCKETSApplication Form for Individuals Not AffiliatedWITH PERMITTED CLUBSName of Applicant:Street Address:City/State/Zip:______________________________AMA#____________/Status___________________________________________________________________________________________________Telephone Number(s): Day____________________Evening___________________FLIGHT RESTRICTIONS - AIRCRAFT -- If the above-named individual is a NEW FLYER orNOVICE they shall not fly without an instructor present.To the applicant: Once you have passed the Flying Qualification Test and have been certified to fly solo, bring thisform to the Park Manager to have your annual permit & flying status updated.______________________________________________________________________I hereby certify that the above-named individual has passed the Flying Qualification Test andmay be issued a Pilot’s Annual Permit for individuals.Instructor’s Name:__________________________________AMA#_____________Instructor’s Club:_____________________________________________________Instructor’s Signature:_________________________________________________Date:_______________________ Test Location:___________________________FLIGHT RESTRICTIONS – ROCKETS – Class ‘C’ rockets or smaller only. Rockets that arein-flight radio-controlled are prohibited. Minors must be accompanied by an adult.Scheduled athletic events have priority over all rocket launches.FLIGHT RESTRICTIONS-- ALL -- Yearly- Applicant(s) are to submit CURRENT certificateof insurance, current AMA card, flying status (if applicable) and annual permit fee to ParkManager if renewal processing is desired. Permits expire Dec. 31. Restrictions may changewithout notice.6 of 7