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Golden Gardens Park In -Water Dog Training Permit Application <br /> 1. Applicant Information: <br /> Name: Phone: <br /> Address: City /Zip: <br /> E -Mail Address: <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 /> Color <br /> Age <br /> Rabies vaccination date <br /> Rabies expiration date <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 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 permit. <br /> Signature Date Print Name <br /> {00090457;1 } Golden Gardens Park - In -Water Dog Training Permit Application Page 1 <br />