I, ____________________(print your name) certify that I am the owner or the agent of the owner of _______________(print your dog’s name), and that I am authorized to purchase items or render services for the pet and sign this form.

I understand that The Dog Park ! (herein known as TDP) reserves the right to refuse use of TDP facilities to any pet or pets who, in TDP sole discretion and determination, act aggressively, evidence behavior deemed detrimental to the group or facility or may otherwise be a danger to themselves or other animals, staff or users.

I acknowledge that dogs are encouraged to socialize, exercise and engage in play in an off leash setting at TDP and that injuries to either pets or owners or their guest might be foreseen to result from such off leash play or roughhousing that may occur within our facility. I agree that TDP shall not be responsible for injuries or illnesses to myself, my pet(s), my guests and invitees, and shall indemnify TDP for any costs, damages, claims or expenses that may result there from. I further acknowledge that TDP shall not be held responsible for any illness, ailment or injury that may occur or affect my dog during its visit or stay at TDP.

I authorize TDP to contact my veterinarian in order to confirm health, temperament and vaccinations. If, in my absence, my pet should be injured, become ill or suffer an ailment or is otherwise deemed by TDP to require immediate veterinary attention, TDP is authorized to consult with my veterinarian. If my veterinarian is unavailable or located at too great of a distance, TDP is authorized to utilize the services of another licensed veterinarian during my stay or visit to TDP. I understand that I shall be responsible for any and all charges with respect to such veterinary care. Further, should I be required to take my pet to a veterinarian after a stay or visit to TDP, I understand that I am solely responsible for any and all veterinary or other related or unrelated charges; TDP shall in no way be responsible for same.

I agree that the likeness of me, my family members, guests or pets may appear on TDP’s website, advertising, printed materials, press or other coverage from time to time.

I understand that if my dog is left for more than 5 days after the scheduled pick up time, my dog will be considered abandoned and necessary steps will be taken. Further, I authorize that in the event that I can not, for any reason, pick up my dog on the scheduled pick up date, you have my permission to contact my emergency delegate and to allow them to pick up or make decisions for the care and disposition of my dog. Further, it is agreed that this person will be responsible for payment upon pick up of my dog.