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Golden Gardens Park In -Water Dog Training Permit Application <br />1. Applicant Information: / <br />Name: J i� � �a l tom{ l Phone <br />Address: � U 0 S`,`ir,ii 4 o- at­''S , City /Zip: t=" Z `77 0'/ <br />E -Mail Address: Ou, w 4 t1 Loa X C& b <br />2. Animal Information <br />(Include all dogs to be engaged in in -water training at Golden Gardens Park, list additional dogs on <br />reverse side): <br />a) Dog #1 <br />Breed ` (I � <br />/- <br />Color L_OC <br />Lv +Gk <br />Age 3 5 <br />5. <br />Rabies vaccination date <br />11 <br />Rabies expiration date <br />— I ). - /Y <br />Dog License Number <br />b) Dog #2 <br />Breed <br />Color <br />Age <br />Rabies vaccination date <br />Rabies expiration date <br />Dog License Number <br />3. Signature <br />I certify that the information I am providing herein is true to the best of my knowledge. I have <br />received a copy of Administrative Order No. 58- 13 -07, and the Eugene Park and Open Space Rules, <br />and I agree to comply with all applicable regulations. I understand that any violation of any <br />provision of the Administrative Order may result in the City revoking the permit and may be a basis <br />for the City to deny a future permit application. I agree to indemnify, defend, and bold harmless the <br />City of Eugene, its officials, agents and employee from and against any and all claims of injury to <br />property or persons that may arise as a result of in -water dog training activities for which I seek <br />this permit. I agree to pay all costs of any damage and /or vandalism to the park or facilities used in <br />relation to this per l <br />Signature _ Date Print Name <br />Ioo090457;1 I Golden Gardens Park - In -Water Dog Training Permit Application Page 1 <br />