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Glenlakes Dog Park Application
(If registering more than two dogs per household, please submit a second application)
Step I. Dog Owner Information:
Name: ____________________________________________________________
Home Phone: ________________________________ Cell Phone: _______________________________
Address: _______________________________________ City: ___________________ Zip ____________
E-mail ________________________________________
Step II. I have read and understand all the Dog park rules and policies: (initials)______(date)__________
Step III. Dog Information:
Dog Name: _____________________________
Breed: _________________________________
Color: ______________ Male: ____ Female ____
0 Attached is a signed verification form from veterinarian
Dog Name: _____________________________
Breed: _________________________________
Color: ______________ Male :____ Female ____
0 Attached is a signed verification form from veterinarian
Step IV .
0 I have read, understand and attached a signed copy of the liability waiver (initials)______(date)_________
Step V. Fee/tag: Lakeview Residents – $10 year
Glenlakes Residents – $25 year
If paying by check, make check payable to the “Glenlakes Dog Park”
Cash______ Check #_____________
Total Dogs ________ Total Amount of Payment __________ Staff Initials ____________
Authorized Signature ______________________________________________________
.OFFICE USE ONLY for First Dog Office USE ONLY for Second Dog
Dog Tag #:_____________________________ Dog Tag#: ____________________
Dog Name: _____________________________ Dog Name: ___________________
0 Signed vet form 0 Signed vet form
0 Signed liability waiver 0 Signed liability waiver
0 Payment (receipt attached) 0 Payment (receipt attached)
0 Tags issued date ___________ initials ______ 0 Tags issued date __________ initials _______
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