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2015 Golden Gardens Park In -Water Dog Training Permit Application <br />1. Applicant Information <br />Name: Phone: <br />Address: <br />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 />aj Dog #Z Name: <br />Breed <br />Color <br />Age <br />Rabies vaccination date <br />Provide copy <br />Rabies expiration date <br />Provide copy <br />Dog License Number <br />Provide copy <br />b) Dog #2 Name: <br />Breed <br />Color <br />Age <br />Rabies vaccination date <br />Provide copy <br />Rabies expiration date <br />Provide copy <br />Dog license Number <br />Provide copy <br />3. Signature <br />I certify that the information I am providing herein is true to the best of my knowledge. l 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 parr or facilities used in <br />relation to this permit. <br />Signature Date Print Name <br />100090457;11 Golden Gardens Park - Ire -Water Dog Training Permit Application Page 1 <br />