Dog Park Application/Annual Renewal

Hazleton Area Dog Owners Group
HAZADOG
P.O. Box 2033
Hazleton, PA 18201

570-790-8111 or 570-956-3247

HAZLETON AREA DOG PARK APPLICATION/ANNUAL RENEWAL

PLEASE NOTE:

Bailey's Dog Park is a private, members only dog park. The fee for using the dog park is $72.00 yearly April 1st. This fee is used to maintain the park.

A completed application including liability waiver, proof of
rabies vaccination and current dog license is REQUIRED each year)

**PLEASE NOTE: If any part of this application is not complete, you will not be issued a key fob/your key fob will be turned off and you will not be able to access the dog park.

Dog Owner Information

Name
Address

Phone Number(s)

Primary Cell Number
Secondary Cell Number
Home Phone Number
Email

Dog Information (Up to 3 dogs living at the same address are allowed on one membership)

Dog #1

Name of Dog
Breed
Gender
Weight
Date of Birth & Current Age OR Date of Adoption & Current Age
Rabies Expiration Date
Dog License Number
Lifetime License (select one)
Yes
No
Lifetime License Number
County Issuing Dog License

Dog #2

Check here if not applicable
Not applicable
Name of Dog
Breed
Gender
Weight
Date of Birth & Current Age OR Date of Adoption & Current Age
Rabies Expiration Date
Dog License Number
Lifetime License (select one)
Yes
No
Lifetime License Number
County Issuing Dog License

Dog #3

Check here if not applicable
Not applicable
Name of Dog
Breed
Gender
Weight
Date of Birth & Current Age OR Date of Adoption & Current Age
Rabies Expiration Date
Dog License Number
Lifetime License
Yes
No
Lifetime License Number
County Issuing Dog License

By signing this application, I agree to follow all dog park rules that are clearly posted at the entrance and around the dog park. If l or my dog(s) violate any of the rules of the dog park I understand that my membership may be immediately terminated and my monetary membership will not be refunded.

Signature
Clear
Date

Additional Information (please check all that apply) (Hold down CTRL key on computer to select multiple items)

Enter Field Title
If you selected that you want to donate an amount above the $60 annual fee, please indicate that amount below:

Acceptance of Risk & Release of Liability Waiver Acceptance of the terms and conditions of the release and adherence to the Rules and Regulations of the Bailey's Bark Park Dog Park are conditions of the approval, retention, and renewal of the Bailey's Bark Park key fob or card. Fob and or cards are non-transferable between owners and may be revoked for any non-compliance with the Park Rules and Regulations in the direction of the Board of Directors. I do hereby acknowledge and agree that I have voluntarily applied to utilize with my dog(s), Bailey's Bark Park I fully understand and acknowledge that unleashing my dog and being physically present at the dog park involves risk of injury to me, any individual accompanying me, other persons, my dog(s) and other dog(s), included but not limited to risks resulting from aggressive dogs, unpredictable behavior and lack of proper training. I further understand and acknowledge that despite the efforts of the Board of Directors of Bailey's Bark Park to ensure the owners have complied with the Rules and Regulations, there is a risk that not all dogs present at the park are licensed and vaccinated for rabies as maybe required, which could result in injury to a person or a dog. Additional risks include but are not limited to; dog fights, dog bites, theft or unlawful capture escape under or over the fences or through an open gate, vegetation or standing water that may unhealthy or poisonous if consumed, burrs or seeds that may become lodged in the dog( s) coat, feet, eyes, nose or eats, mosquitoes, ticks, chiggers, spiders, :fleas, or other insects, and wildlife typically found in and around the park. I understand and agree that usage of the dog park is self-directed and will not be directly supervised by the City of Hazleton employees. I understand and acknowledge that I assume any and all risks associated with the usage of the dog park. By accepting the prescribed terms and conditions and signing the release, I do hereby agree to indemnify and save harmless Bailey's Bark Park, Bailey's Bark Park Directors, HAZADOG Board of Directors, Tri Area Recreation, The City of Hazleton, any and all property owners and lessors, any volunteers, any employees, any agents, any officers, and any assigns from and against all loss, costs, damages expenses and liability resulting from my use of the dog park, including but not limited to death, sickness, injury, and disease to any person or dog, or destruction to property, real or personal, arising directly or indirectly from any use of the dog park. BY SIGNING THIS AGREEMENT I HEREBY ASSUME ALL THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH BAILEY'S BARK PARK, including by way of example and not limitation, any risk that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained, or controlled by them, or because of their possible liability without fault.BY SIGNING THIS AGREEMENT, I AM CONSENTING TO W AIVE VALUABLE LEGAL RIGHTS TO SUE FOR ANY INJURY RESULTING FROM MY VISITATION TO THE PARK, ANY EQUIPMENT USED AT THE PARK, OR ANY OTHER VISITORS OR PETS BROUGHT TO THE PARK. BY SIGNING THIS AGREEMENT, I ASSUME ANY AND ALL RISKS of entering an off-leash dog park and agree fully and forever release, indemnify, and hold harmless any person or entity involved in but not limited to: creating, designing, or overseeing the park, surroundings, or items included. I CERTIFY THAT I HAVE READ THIS DOCUMENT, I FULLY UNDERSTAND ITS CONTENT, AND AM NOT UNDER THE INFLUENCE OF ANY SUBSTANCE, WHICH MAY ALTER MY ABILITY TO UNDERSTAND ITS CONTENT. I AM AW ARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. Thank you, Board of Directors

Print Name
Signature
Clear
Date
Submit

About

The Greater Hazleton Area is located at the foothills of the Pocono Mountains, a popular vacation destination that offers year-round recreation.

It's the Greater Hazleton Area's excellent quality of life that makes the area so attractive to people and businesses from all around the world.

Contact

  main:
570.459.4960
police non-emergency:
570.459.4940
  info@hazletoncity.org
  City of Hazleton
40 N. Church St., Hazleton, PA 18201
  Office Hours: Monday- Friday 8:30 am – 4:00pm (Closed on all federal holidays)

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