Type Full Name :

Sign With Hand

You may add the names of additional handlers over 18 years old who may be responsible for dog(s) at the park. Limit three (3).

Certification

Address *

Fee Due

{[PNAME]}

Phone Number *

Add a record below for each dog who will be using the Park. Limit of three (3) dogs per owner or permitted handler inside the dog park at any one time.

Preferred Payment Method *

State *

Applicable Fees

City *

Dog Owner Information

ZIP *

Name of Additional Handler

Additional Handlers

Name of Additional Handler

Sign Here *

Dog Information

Residents: $3.00 per Dog, Non-residents: $7.00 per Dog.

Payment may be made in the form of a check or money order made out to "The Borough of Lodi" and mailed or hand-delivered to:
Borough of Lodi, Clerk's Office
{[ADDR]}
Lodi, NJ 07644

Residents: $3.00 per Dog, Non-residents: $7.00 per Dog.

Now you can pay your Application Fee from the comfort of your home or office by using our online payment service. Credit cards accepted: MasterCard, Discover, American Express or Visa. A per transaction service fee of 2.65% or $3.00 minimum will be charged by the payment processing company for this service.

The Borough of Lodi also accepts electronic check payments using our online payment service. Payments will be charged to your checking or savings account at your bank. You will need your 9-digit routing number, as well as your account number from your personal checks. A per transaction service fee of $1.50 will be charged by the payment processing company for this service. IMPORTANT: When Payment Options appears, click on the 'Switch to Pay with Check' link and then continue entering your information.

You will be sent instructions on how to use this payment feature once your application is reviewed.

Payment may also be made in the form of a check or money order made out to "The Borough of Lodi" and mailed or hand-delivered to:
Borough of Lodi, Health Department
{[ADDR]}
Lodi, NJ 07644

ZIP *

Owners are required to submit proof of vaccinations and spay/neuter records for all dogs and proof of residency. Once all documentation is reviewed and processed successfully a permit tag will be issued per dog. *

Attachments

Email *

Service Fee (if applicable)

{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[PPHONE]}
{[AWEBSITE]}

I certify that the information submitted in this application is true and correct to the best of my knowledge.

{[CNAME]}

Are you a resident? *

State *

RELEASE, WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

I hereby certify that I am over 18 years of age and of sound mind and memory at the time of executing this agreement. WHEREAS, the {[CNAME]}, (hereinafter “the Borough”) has made available a designated off-leash dog park “Dog Park” ; and by executing this Agreement and agreeing to be bound by its terms, the Borough agrees to allow me access to the dog park to participate in off-leash activities with my dog(s) so long as I follow all rules, regulations and ordinances set forth. NOW THEREFORE, in consideration of being allowed to participate in such activities, I hereby agree as follows:
1. I am aware of and fully understand the inherent dangers involved in participating in activities at the offleash dog park, including risk of death, personal injury and property damage/loss to myself, my minor(s), my dog(s), designated handlers, and other persons and their dogs while participating in such activities. I further acknowledge that all of the aforementioned as well as other persons and their dogs at the dog park are not covered by the insurance of the Borough. I freely and voluntarily execute this Agreement with such knowledge and assume full and sole responsibility for the risk of death, personal injury and property damage/loss connected in any way with my dog(s), my minor(s), my designee(s), or my own presence or participation in any activities at the dog park,
2. I hereby release and forever discharge the Borough and its employees, agents, governing body or independent contractors and their respective insurers, successors, assigns and legal representatives from any liability, claim, cause of action, demand or damages for the death, personal injury, or property damage/loss of any kind to my dog(S), my minor(s), my designee(s) or myself as a result of presence or participation in dog park activities, whether such death, injury pr property damage/loss is caused by the intentional or negligent act or omission by any employee, agent or independent contractor of the Borough or any other person(s) or dog(s) at the dog park
3. I agree to indemnify and hold the Borough and its employees, agents, governing body or independent contractors and their respective insurers, successors, assigns and legal representatives harmless from any liability, claim, cause of action, demand or damages for the death, personal injury or property damage/loss of any kind to any person or property as a result of my participation, or that of my dog(s), my minor(s) or my designee(s) in dog park activities, regardless of whether such death, injury, or property damage/loss is caused by the intentional or negligent act or omission by me or my dog(s), my minor(s) or my designee(s) while participating in dog park activities or in the dog park.
4. By executing this Agreement, I hereby bind my heirs, executors, assigns, and all other legal representatives, as well as those of my minor(s) and designee(s).
5. I agree that this Agreement is intended to be interpreted as broadly and inclusively as permitted by the laws of the State of New Jersey. If any portion of this Agreement is found or declared to be invalid or unenforceable, such invalidity shall not affect the remainder of this Agreement, which shall remain in full force.
6. I agree to abide by all rules, regulations and ordinances that the Borough may oppose now or in the future regarding dog park use and operation.
7. By executing this Agreement, I certify that I have read and understand this Agreement, have freely and independently executed this Agreement and have received a copy of the dog park rules. I also certify that I have made my dog’s alternate handler(s) (18 years of age or older) aware of this agreement and all dog park rules.

Address *

Name *

City *

Registration Type *

Name of Additional Handler

Veterinarian Information

Phone Number *

Name *