Name:

Address:

City: Zip: Phone:

Non-Resident Card #: Dog Tag #:

License #: RESIDENT FEE NON-RESIDENT FEE

DOG PARK SEASON TAG $20.00 $30.00

DOG PARK DAY BAND $ 2.00 $ 3.00

In consideration of the acceptance of myself and my dog’s purchasing of this use permit, I hereby waive for myself and my dog, my heirs, and assigns, all claims for damage which I might have against the Oconomowoc Parks, Recreation and Forestry Department, or the City of Oconomowoc, or any other participating agency and their employees for any and all injuries which I or my dog might receive during this activity. I further understand that the Oconomowoc Parks, Recreation and Forestry Department does not carry medical accident insurance.

Signature:

Name:

Address:

City: Zip: Phone:

Non-Resident Card #: Dog Tag #:

License #: RESIDENT FEE NON-RESIDENT FEE

DOG PARK SEASON TAG $20.00 $30.00

DOG PARK DAY BAND $ 2.00 $ 3.00

In consideration of the acceptance of myself and my dog’s purchasing of this use permit, I hereby waive for myself and my dog, my heirs, and assigns, all claims for damage which I might have against the Oconomowoc Parks, Recreation and Forestry Department, or the City of Oconomowoc, or any other participating agency and their employees for any and all injuries which I or my dog might receive during this activity. I further understand that the Oconomowoc Parks, Recreation and Forestry Department does not carry medical accident insurance.

Signature: