friends of the johnson city jcdpa use: dog park ... · dispute resolution form should be filled...
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Friends of the Johnson CityDog Park Association, Inc.
Membership Registration Form
Name (one person only): ______________________________________________________
Address: ___________________________________________________________________
City, State, Zip: _____________________________________________________________
Email Address: _____________________________________________________________
Cell Phone: __________________________ Home Phone: _______________________
New Member Renewing Member
I agree to receive Association correspondence by email.
Signature: ___________________________ Date: ______________________________
By signing above I agree to the city liability, association liability, and park rules.
The membership fee is $25.00. Members do not have to have a registered dog, but gate access keys are onlyissued to members with registered dogs, and only registered dogs may use the park. Half-priced fees ($12.50)are available October 1st to January 31st. After January 31st, full priced registrations run from the date ofregistration to March 31st of the following year.
The registration fee is $20.00 per year for each dog. Half-priced fees ($10 per dog) are available October 1st
to January 31st. After January 31st, full priced registrations run from the date of registration to March 31st of thefollowing year.
Dog #1 Name: ________________________ Breed: ____________________________
Dog #2 Name: ________________________ Breed: ____________________________
Payment: Membership fee: $_____________________ ($25.00 per membership)
Dog registration fee(s): $________________ ($20.00 per dog)
Total enclosed: $_______________________
Please mail payment, Membership Registration Form, Authorized User Form (if applicable), and copiesof each dog’s vaccination (Rabies, Parvo, Distemper, and Bordatella) and spay/neuter records to:
Johnson City Dog Park Association, Inc.P.O. Box 4691
Johnson City, TN 37602-4691
JCDPA USE:
Key #____________
P.P. #_____________
Friends of the Johnson City Dog Park Association, Inc.
Authorized User Form
Authorized User's Information:Name (one person only): ________________________________________________________
Address:______________________________________________________________________
City, State, Zip:________________________________________________________________
Email Address:________________________________________________________________
Home Phone:_________________________Cell Phone:_______________________________
An authorized user is not a member of the Friends of the Johnson City Dog Park Association,Inc. and thus is not entitled to vote on Association matters and may not register dogs to use thepark independent of the authorizing member listed below.
Authorized user: By signing below you are agreeing to the city liability, associationliability, and park rules.
Signature:_________________________________
Date:_______________________________
Member's Authorization:By signing below, I authorize the above person to use my gate access key, and bring myregistered dogs to the park. I accept full and total responsibility for the Authorized User and mydog(s) when they are at the park, whether or not, I am in attendance.
Member's Name (please print):___________________________________________________
Signature:_________________________________
Date:_______________________________
For FJCDPA, Inc. use only
Member's Gate Key #____________________
!!Rules Form!
!Dogs:!!• Dogs must wear permanent ID, soft collar, and dog park ID (Pooch Pass)!• Choke, chain, spiked or other such collars are strictly prohibited!• Dogs must be spayed or neutered unless exempt under the Johnson City
bylaw!• Female dogs in heat are strictly prohibited! !• Dogs must be current on the required vaccinations - Rabies, Distemper,
Parvo, and Bordetella!• Dogs exhibiting aggressive behavior must be removed from the park!• Dogs deemed aggressive or excessively loud may be banned from the
park without a refund of annual membership fees!• Unleash your dog in the double gate area - DO NOT enter the park with a
leashed dog!!Owners:!!• You must have your Gate Access Key Card to enter the park!• Always clean up after your dog!• Never leave your dog unattended in the park!• Children under 12 years of age are strictly prohibited from the park!• No smoking or tobacco products are allowed in park!• You and your dog enter and exit the park at your own risk!• No eating or drinking is allowed in the park!• Alcohol is not allowed in the park!• Park membership expires March 31st of each year!• Replacement cost for a Gate Access Key Card is $10.00!• Failure to observe park rules will result in cancellation of your
membership!• Dispute resolution form should be filled out for any park altercation!!
Friends of the Johnson City
Dog Park Association, Inc.
Association Liability Form
I hereby acknowledge that I have voluntarily applied to participate and use, with my dog(s), the dog park
located within Willow Springs Park in Johnson City, TN (the Dog Park). I understand that the act of
unleashing my dog(s) and being physically present inside the Dog Park may involve risks of injury to
myself, other persons, my dog(s), and other dogs, which risks are entirely my responsibility. I expressly
assume all of these risks. I further understand that dogs, irrespective of their training and usual past
behavior or characteristics, may act or react unpredictably at times based upon instinct or circumstances,
and I agree to assume the risk of injury to me, any individual accompanying me or my dog(s) in the Dog
Park. I understand that this risk may result from aggressive and /or dangerous dogs, which may be
present in the Dog Park. I further understand and assume the risk that not all dogs present in the Willow
Springs Dog Park have received the Rabies vaccine as required by law, and that not all dogs using the
Dog Park have been vaccinated for Distemper, Parvo or Bordetella, all of which could result in injury to
me, my dog(s) or the Authorized User for my dog(s). Additional risks include, but are not limited to: dog
fights, dog bites and injuries to humans and other dogs; dog theft or unlawful capture; dog escape over or
under fences; plants and/or water sources of the park may be poisonous to dogs; park vegetation may
have burrs or seeds that could become tangled in a dogʼs coat or lodge in a dogʼs feet, ears, nose, or
eyes, mosquitoes, ticks, chiggers, fleas or other insect may be present; wild animals such as skunks,
raccoons, opossums, or stray dogs could be present in the park, all of which might injure or infect my
dog(s). I understand and expressly assume all of these additional risks.
It is my understanding that no agent or employee of the Friends of the Johnson City Dog Park,
Association, Inc. (the Association) will supervise the Dog Park at any time. I further understand the
Association does not assume liability for loss, damage, or any kind of injury sustained by any human or
dog while using the Dog Park. I, therefore, expressly assume all risks associated with using the Dog Park,
as well as fixtures and equipment located therein, in an unsupervised manner.
By signing this release of liability and acknowledgment of use condition and terms of the Dog Park, I
hereby fully and forever release and discharge the Association and their employees, agents, and
assigned from any and all claims, demands, damages, rights of actions, or causes of action present or
future, whether the same be known or unknown, anticipated or unanticipated, resulting from or arising out
of my use or intended use of the Dog Park.
I fully and forever release and discharge the Association, and their employees, agents and assigned from
any and all negligent acts and omissions in the same, and intend to be legally bound by this release.
I have carefully read this release of liability and understand and fully acknowledge and agree with its
contents.
This is a release of liability. Do not sign if you do not understand or do not agree with its terms.
Friends of the Johnson City
Dog Park Association, Inc.
City Liability Form
I hereby acknowledge that I voluntarily have applied to participate and use, with my dog(s), the Willow
Springs Dog Park at Willow Springs Park. I understand that the act of unleashing my dog(s) and being
physically present inside the Willow Springs Dog Park may involve risks of injury to myself, other persons,
my dog(s), and other dogs, which risks are entirely my responsibility. I expressly assume all these risks. I
further understand that dogs, irrespective of their training and usual past behavior or characteristics, may
act or react unpredictably at times based upon instinct or circumstances, and I agree to assume the risk
of injury to me, any individual accompanying me or my dog(s) in the Willow Springs Dog Park. I
understand that this risk may result from aggressive and /or dangerous dogs, which may be present in the
Willow Springs Dog Park. I further understand and assume the risk that not all dogs present in the Willow
Springs Dog Park have received the Rabies vaccine as required by law, and that not all dogs using the
Willow Springs Dog Park have been vaccinated for Distemper, Parvo or Bordetella, all of which could
result in injury to me, my dog(s) or the authorized companion for my dog(s). Additional risks include, but
are not limited to: dog fights, dog bites and injuries to humans and other dogs; dog theft or unlawful
capture; dog escape over or under fences; plants and/or water sources of the park may be poisonous to
dogs; park vegetation may have burrs or seeds that could become tangled in a dogʼs coat or lodge in a
dogʼs feet, ears, nose, or eyes, mosquitoes, ticks, chiggers, fleas or other insect may be present; wild
animals such as skunks, raccoons, opossums, or stray dogs could be present in the park, all of which
might injure or infect my dog(s). I understand and expressly assume all of these additional risks.
It is my understanding that no agent or employee of Parks and Recreation Department or the City of
Johnson City will supervise the Willow Springs Dog Park at any time. I further understand that neither
Parks and Recreation or the City of Johnson City assumes liability for loss, damage, or any kind of injury
sustained by any human or dog while using Willow Springs Dog Park. I, therefore, expressly assume all
risks associated with using the Willow Springs Dog Park, as well as fixtures and equipment located
therein, in an unsupervised manner.
By signing this release of liability and acknowledgment of use condition and terms of the Willow Springs
Dog Park, I hereby fully and forever release and discharge the City of Johnson City, Parks and Recreation
and their employees, agents, and assigned from any and all claims, demands, damages, rights of actions,
or causes of action present or future, whether the same be known or unknown, anticipated or
unanticipated, resulting from or arising out of my use or intended use of said Willow Spring Dog Park.
I fully and forever release and discharge the City of Johnson City, the Johnson City Parks and Recreation
and their employees, agents and assigned from any and all negligent acts and omissions in the same,
and intend to be legally bound by this release.
I have carefully read this release of liability and understand and fully acknowledge and agree with its
contents. I also have received a copy of the brochure outlining rules for use, and I agree to read the
brochure before the first visit to the Willow Springs Dog Park.
This is a release of liability. Do not sign if you do not understand or do not agree with its terms.