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Golden Gardens Park in -Water Dog Training Permit Application <br />1. Applicant Information: <br />Name; � t c, U) z - L Z't Phone � �� - . <br />Address: C 2, & (" ' t A o 0. 0 A ut_city /zip: <br />H -Mail Address: e 0 V -' ` > t s E C <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 _ <br />, { c i e .4� �5 Pre t x" 4-' r4 <br />Color <br />L V-7 •. L-t v C - — <br />�A e <br />Rabies vaccination date <br />- 1 1 " v - 'I <br />Rabies expiration date <br />i <br />Do 'Liceese Number <br />Aica,L,r r` L A, ', . <br />la) Dog #2 <br />Breed. <br />` 6�11,,t '. hi c "isL :t; e�'F- <br />Color <br />V E %Z- <br />Rabies vaccination date <br />a_ <br />Rabies expiration date <br />1 <br />Dog License Number <br />C 4 iZ,tA $ ' C t 2 1 <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 al] 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 hold 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-perm i <br />s . <br />Signature Date Print.Name' <br />{00090457:1. } Golden Gardens Park W In•Water Dog Training Permit Application Page -I <br />