WHS Dog Park Application
You will need to bring the application, a record of rabies vaccination for each animal using the park and a driver's license or other picture ID.
CLICK HERE TO PRINT THIS APPLICATION
Temp#____________ Perm# _________________
Owner __________________________________________________
Address________________________________________________________
City ________________________________ State__________ Zip________
Preferred Phone _______________________Driver’s License #____________________ State _____
Email _________________________________________________________
Dog 1
Dog’s Name ________________________________________
Breed_______________________________
Color ______________________________ Age__________ Sex M F Spay/Neuter Y N
Rabies Tag #_________________________ Date Given _______________
Expires________________
Vet Name or Practice____________________________________________________________
Dog 2
Dog’s Name ________________________________________
Breed_______________________________
Color ______________________________ Age__________ Sex M F Spay/Neuter Y N
Rabies Tag #_________________________ Date Given _______________
Expires________________
Vet Name or Practice____________________________________________________________
Acceptance of Risk and Release of Liability: Acceptance of the terms and conditions of this release and adherence to dog park rules are conditions of membership approval, retention and renewal. Membership may be revoked for non-compliance.
I hereby acknowledge that I have voluntarily applied to participate and use, with my dog(s), designated park areas operated by the Watauga Humane Society (WHS). I understand that unleashing my dog(s) and being physically present at the dog park involves risk of injury to me, any individuals accompanying me, other people, my dog(s), including but not limited to, risks resulting from aggressive dogs, unpredictable behavior, and lack of training. I further understand that despite the efforts of WHS to ensure that owners have complied, there is a risk that not all dogs present in the dog park are licensed and vaccinated as required by law which could result in injury to a human or a dog. Additional risks include but are not limited to: dog fights; dog bites; theft or unlawful capture; escape over fences; vegetation or standing water that may be poisonous if consumed; burrs or seeds that may become lodged in dog’s coat, feet, eyes, ears or nose; mosquitoes; chiggers; fleas, and other insects; and wildlife typically found in a park such as snakes, raccoons, etc. It is my understanding that use of the dog park is self-directed and not directly supervised by an agent or employee of WHS. I assume all risks associated with using the dog park, including fixtures and equipment, in an unsupervised and self-directed manner.
By signing this release, I agree to indemnify and serve harmless WHS, its agents, officers and employees and assigns form and against all loss, cost, damages, expense and liability resulting from my use of the dog park, including death, sickness, injury, and disease to any person or dog or destruction to property, real or personal, arising directly from my use of the dog park. I read this release of liability and understand, agree with, and accept its terms and conditions. I have also received a copy of the rules for dog park use and agree to abide by these rules.
Signature__________________________________________________________ Date_______________________
Issued by/Witness____________________________________________
Regular $85 Seniors (over 65) $65 Student $60 6 Month $65 1 Month $20 Week $30
3 Day $25 1 Day $10
Each addition dog $15 per year
Cash Credit Debit Check TOTAL $ ______________