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Chester Avenue Dog Park
Home
Members
Photo Directory
Volunteer
Documents
Report an Incident
Meeting Minutes
We Remember
Events
Park Pictures
Holiday 2017
Howl-O-Ween 2017
Park Pics
FACEBOOK
Apply
APPLY ONLINE
Application form
Waiver
Open Application form
Application Form
Human 1:
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First Name
Last Name
Email 1:
Phone 1:
*
(###)
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Human 2:
Skip if only one human
First Name
Last Name
Email 2:
Phone 2:
(###)
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Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact/Phone:
(###)
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Dog walker/authorized user(s):
Dog's Name:
*
Breed:
*
If not known, enter your best guess.
Rabies' vaccine expiration date:
*
MM
DD
YYYY
License #:
*
License expiration date:
*
MM
DD
YYYY
Thank you
waiver
WAIVER
CHESTER AVENUE DOG ASSOCIATION: Membership year 2015-2016
CHESTER AVENUE DOG ASSOCIATION: Membership year 2014-2015 MUST BE SIGNED ANNUALLY BY ALL HOUSEHOLD MEMBERS WHO USE THE PARK, DOG WALKERS OR OTHER AUTHORIZED USERS:
1. WAIVER AND RELEASE OF LIABILITY AN INDEMNIFICATION
*
In consideration of being granted access to the dog park operated by Chester Avenue Dog Association (CADA), located on real property at 48th Street and Chester Avenue (Real Property) owned by Renaissance Healthcare and Rehabilitation Center (Renaissance), I hereby waive, remise, release and forever discharge CADA and Park Renaissance and the respective parents, subsidiaries, affiliates, partners, associates, principals, directors, officers, members, employees, attorneys, and agents of each of CADA and Renaissance, and the successors and assigns of each of them, from any and all liabilities, actions, suits, debts, judgments, claims and demands whatsoever in law and in equity arising out of or connected to any entry on or to, or presence on, or use of, said Real Property, including but not limited to, any and all liabilities, actions, suits, debts, judgments, claims and demands related to injury to my person, my personal property or any animals owned by me or under my control, or anyone as a result of my action or inaction, whether caused by negligence or otherwise, which I ever had, now have, or may have at any time in the future. In addition, I agree to indemnify and defend CADA and Renaissance and their respective parents, subsidiaries, affiliates, partners, associates, principals, directors, officers , members, employees, attorneys and agents of each of CADA and Renaissance, and the successors and assigns of each from any and all liabilities, actions, suits, debts, judgments, claims and demands whatsoever in law and in equity arising out of or connected to my entry on, to or presence on, or use of, said Real Property, or the entry on, to, or presence of anyone else thereon as a result of my action or inaction, including but not limited to, any and all liabilities, actions, suits, debts, judgments, claims, demands, attorneys’ fees, costs and expenses that any of the foregoing may sustain in any way related to, arising out of or in any way connected to my entry on, to or presence on, or use of, said Real Property. This Waiver and Release of Liability and Indemnification may not be modified except by a writing signed by me, CADA, and Renaissance. I understand that this waiver is binding on my heirs and assigns. My signature certifies that I have read and fully understand this Waiver and Release of Liability and Indemnification.
I have read about Waiver and Release of Liability and Indemnification.
2. WORK RULE REQUIREMENTS
*
I (we) understand that all member households are required to volunteer eight (8) hours of time in support of the upkeep, management & volunteer activities at the dog park or Renaissance activities between October 1, 2015 and September 30, 2016. I (we) understand that failure to complete the work hours will result in my household NOT being allowed to renew the following year.
I have read about Work Rule Requirements.
NOTICE TO MINORS
Notice to Minors If you are under eighteen (18) years of age, your parent or legal guardian must sign: I, being the parent or legal guardian of the above-signed, who is under the age of eighteen (18), do hereby consent that the above-signed may enter on to the real property owned by Park Pleasant and do hereby certify that I have read, fully understand and adopt entirely the above recited “Waiver and Release of Liability”.
3. REFUND OF MEMBERSHIP DEPOSITS
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I (we) understand that it is the responsibility of the MEMBER to contact the CADA treasurer to arrange for the return of the membership deposit at the end of our membership. I (we) understand that if I (we) do not request a refund of the deposit within six months of the end of the membership, such funds will become the property of CADA.
I have read about Refund of Membership Deposits.
4. DEMOGRAPHIC CHANGES
If your address, phone or email has changed since you joined the park please indicate below so that we may update the database
SIGNATURE 1
*
Every authorized user named in the application must sign.
SIGNATURE 2
SIGNATURE 3
Thank you.