State of New Jersey Department of Environmental Protection Division of Parks and Forestry New Jersey State Park Service Mail Code 501-04 P.O. Box 420 Trenton, New Jersey 08625-0420 D E P A R T M E N T O F E N V I R O N M E N T A L P R O T E C T I O N D E P A R T M E N T O F E N V I R O N M E N T A L P R O T E C T I O N N E W J E R S E Y D I V I S I O N O F P A R K S S T A T E P A R K S E R V I C E A N D F O R E S T R Y N. J. Explore New Jersey’s State Parks & Forests Qualification • Age 62 or older. Benefits • Provides free entrance to all state park, forest, recreation area and historic site facilities that charge daily walk-in or parking fees, as well as a $2 per night discount on campsite fees (excluding group campsites). • e senior citizen pass is valid for your lifetime. How to Apply To obtain a senior citizen pass, either visit any park office or mail the completed application on reverse side with supporting documentation. NOTE: A pass does not guarantee entry when facilities are filled to capacity or closed. A pass cannot be used for group visits and is not valid for buses or commercial or group transportation vehicles. All groups must make reservations in advance through the area office and applicable bus fees may apply. Disabled persons and senior citizen groups should contact the park office for applicable fees. Open Public Records Act (OPRA) NJSA 47:1A-1 Information provided on this application may be subject to review and inspection under the Open Public Records Act (OPRA) NJSA 47:1A-1. If you enjoy swimming in crisp, cool waters, hiking the Batona Trail through the Pinelands National Reserve, climbing the Appalachian Trail into the Kittatinny Mountains or touring historic sites and villages, a New Jersey park pass is for you. New Jersey has 43 parks, forests and recreation areas as well as 57 historic sites, representing New Jersey’s natural and cultural legacy, covering more than 450,000 protected acres. Senior Citizen Pass Disability Pass HIGH POINT STATE PARK BARNEGAT LIGHTHOUSE STATE PARK Explore All of New Jersey’s State Parks & Forests D E P A R T M E N T O F E N V I R O N M E N T A L P R O T E C T I O N D E P A R T M E N T O F E N V I R O N M E N T A L P R O T E C T I O N N E W J E R S E Y D IVISIO N O F P A R K S S T A TE PA R K SER VIC E A N D F O R E S T R Y N. J. Qualification • New Jersey residents with a disability. Benefits • Provides free entrance to any state park, forest, recreation area, and historic site facilities that charge daily walk-in or parking fees, as well as a $2 per night discount on campsite fees (excluding group campsites). Many areas and facilities are accessible to persons with disabilities. If you require special accommodations, it is recommended that you contact the area office prior to your visit. • e disability pass is valid for the term of your disability. How to Apply To obtain a disability pass, mail the completed application on reverse side with supporting documentation. Application for a free Senior Citizen or Disability park Pass
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Explore D E TO New Jersey’s R State Parks & Forests · campsite fees (excluding group campsites). • The senior citizen pass is valid for your lifetime. How to Apply To obtain
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State of New
JerseyD
epartment of E
nvironmental Protection
Division of Parks and Forestry
New
Jersey State Park ServiceM
ail Code 501-04 P.O
. Box 420Trenton, N
ew Jersey 08625-0420
DEPARTMENT OF EN
VIR
ON
MEN
TAL PROTECTIO
N
DEPARTMENT OF EN
VIR
ON
MEN
TAL PROTECTIO
N
NEW
JE
RS
EY
DIVISION OF PARKS
STATE PARK
SERVICE
AND
FORESTRY
N. J.Explore
New Jersey’s State Parks & Forests
Qualification • Age 62 or older.
Benefits • Provides free entrance to all state park, forest, recreation area and historic site facilities that charge daily walk-in or parking fees, as well as a $2 per night discount on campsite fees (excluding group campsites). • The senior citizen pass is valid for your lifetime.
How to ApplyTo obtain a senior citizen pass, either visit any park office or mail the completed application on reverse side with supporting documentation.
NOTE: A pass does not guarantee entry when facilities are filled to capacity or closed. A pass cannot be used for group visits and is not valid for buses or commercial or group transportation vehicles. All groups must make reservations in advance through the area office and applicable bus fees may apply. Disabled persons and senior citizen groups should contact the park office for applicable fees.
Open Public Records Act (OPRA) NJSA 47:1A-1Information provided on this application may be subject to review and inspection under the Open Public Records Act (OPRA) NJSA 47:1A-1.
If you enjoy swimming in crisp, cool waters, hiking the Batona Trail through the Pinelands National Reserve, climbing the Appalachian Trail into the Kittatinny Mountains or touring historic sites and villages, a New Jersey park pass is for you.
New Jersey has 43 parks, forests and recreation areas as well as 57 historic sites, representing New Jersey’s natural and cultural legacy, covering more than 450,000 protected acres.
Senior Citizen Pass Disability Pass
HIGH POINT STATE PARK
BARNEGAT LIGHTHOUSE STATE PARK
Explore All ofNew Jersey’s State Parks & Forests
DEPA
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NT O
F ENVIRONMEN
TAL P
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NDEPA
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NT O
F ENVIRONMEN
TAL P
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NEW JERSEY
DIVISION
OF
PARKS
STATE
PARK
SERVICE
AND
FORESTRY
N. J.
Qualification• New Jersey residents with a disability.
Benefits• Provides free entrance to any state park, forest, recreation
area, and historic site facilities that charge daily walk-in or parking fees, as well as a $2 per night discount on campsite fees (excluding group campsites). Many areas and facilities are accessible to persons with disabilities. If you require special accommodations, it is recommended that you contact the area office prior to your visit.
• The disability pass is valid for the term of your disability.
How to ApplyTo obtain a disability pass, mail the completed application on reverse side with supporting documentation.
Application for a free
Senior Citizen or Disability
park Pass
Senior Citizen Pass
Please check off and attach a copy of one verification document.
Age/New Jersey residency verification documents
Valid driver’s license Government issued ID
Disability Pass
Please check off and attach a copy of one disability verification document AND one copy of a New Jersey residency verification document.
Disability verification documents Social Security Certificate of Disability
(Certification of Disability Determination) Supplemental Security Income (SSI)
(Notice of Decision Certificate for Total Disability) Certification by the New Jersey Commission for
the Blind verifying the individual is blind. Medical certification signed by a licensed,
practicing physician. (on next panel)ANDNew Jersey residency verification documents
Valid driver’s license Government issued ID
Allaire State Park4265 Atlantic AvenueFarmingdale, N.J. 07727(732) 938-2371
Wawayanda State Park885 Warwick TurnpikeHewitt, N.J. 07421(973) 853-4462
Wharton State Forest 31 Batsto RoadHammonton, N.J. 08037(609) 561-0024
Worthington State ForestOld Mine RoadColumbia, N.J. 07832(908) 841-9575
Name _______________________________________
Address _____________________________________
City________________State ____ Zipcode ________
Telephone ___________________________________
email _______________________________________
APPLICATION FORM Senior Citizen or Disability Pass
Disability Pass Medical Certification FormThe following information is required to verify the applicant’s request for a free New Jersey State Park Service Disability Pass. A disabled person is defined as a person with a physical or mental impairment that substantially limits one or more of the major life activities. This means the individual is limited in his or her ability to perform such functions as caring for oneself, executing manual tasks, walking, seeing, hearing, speaking, breathing, learning or working.
Applicant’s name ______________________________
Applicant’s address ____________________________
_____________________________________________
1. Please check the extent to which you believe the applicant will be or is disabled.
Permanently TemporarilyIf temporarily, please indicate the approximate date when the applicant in your opinion, would no longer be disabled.
_________Month _________Year
2. I last examined the applicant on _________day of _________ 20____.
_____________________________________________Physician’s original signature Date(STAMP NOT ACCEPTED)
Doctor’s name (please print)____________________________________________
Doctor’s address ______________________________
____________________________________________
Doctor’s telephone number _____________________
MAIL THIS APPLICATION TO:New Jersey State Park Service Mail Code: 501-04P.O. Box 420Trenton, New Jersey 08625-0420