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.