HomeMy WebLinkAbout2023 Dog Park Permit ApplicationIOWA CITY OFF-LEASH DOG PARK PERMITS (TAG) APPLICATION (2023)
All dogs using any Iowa City Off-Leash Dog Park must have a permit tag or a day pass.
Permits are valid from January – December of each year.
To Obtain a Permit, You Will Need the Following:
1. This completed application. Read and sign the Release of Liability on the back of this form (page 2).
2. Iowa City residents are required to obtain a dog license. Dog owners may purchase both a dog license and a dog
park user tag at the Iowa City Animal Care & Adoption Center.
3. Proof of rabies vaccination from your veterinarian.
4. Proof of spay or neuter from your veterinarian to obtain discount.
5. Payment for the total amount due for this permit.
Permits May Be Obtained in Person at the Following Locations: Or Mail to:
Iowa City Animal Services
3910 Napoleon Lane
Iowa City, IA 52240
319-356-5295
Mon-Fri 10:30 am-5:30 pm
Sat. 10:30 am – 3 pm
Robert A Lee Community
Recreation Center
220 South Gilbert Street
Iowa City, IA
319-356-5100
Mon-Fri 8 am-9 pm
Sat. 9 am – 8 pm & Sun. 1-8 pm
Iowa City Animal Services
410 E. Washington St.
Iowa City, IA 52240
Please enclose an additional $2.00 to
cover the costs of shipping &
handling.
Names of Owner(s) Owners DOB Phone Number E-Mail Address
Yes No (circle one)
Street Address Apt # City State/Zip Are you an Iowa City Resident?*
Dog’s Name Dog’s Breed Dog’s Age Male/Fem.
Description of Dog (color, markings) Rabies
Certificate/Tag #
Date of Rabies Expiration
Veterinary Clinic Name Clinic Location
(City)
Clinic Phone Number
Spayed or Neutered?
Yes No
Is your dog licensed through the Iowa City Animal Shelter (this is only
necessary for Iowa City Residents)**
Yes No
IC License#:______________
Microchipped?
Yes No
ID#:________________
Signature(s) of Applicant(s)/Owner(s)
X
Date
Staff Use Only: Issued at: Thornberry Rita’s
Animal Ctr Rec Ctr
Issued By: ________________________________
(PRINT NAME)
Tag Issued: ______________________
Tag # and Year Expires
PERMIT FEES
(Tag expires December 31, 2023)
Iowa City Resident: $55 Nonresident $60
Discount for Spay/Neuter -$5 Discount for Spay/Neuter -$5
total $50 total $55
If mailed add $2.00
Makes checks
payable to: “City of
Iowa City”
Low income discounts
may be available for
Iowa City Residents
OVER
RELEASE OF LIABILITY AND INDEMNIFICATION AGREEMENT
FOR IOWA CITY OFF-LEASH DOG PARKS
I acknowledge that I have voluntarily applied for a permit to use the Iowa City Off-Leash
Dog Parks with my dog(s).
I understand that the act of being physically present in the park where many off-leash
dogs, including my own, will be present involves risks of injury to me, to other people, to
my dog(s), and other dogs. I understand these risks are entirely my responsibility. I
expressly assume these risks. I am aware of the risks and hazards inherent upon being
present at the park and I choose to voluntarily enter the park with my dog(s), knowing the
conditions might become more hazardous and/or dangerous for myself and/or dog(s) and
I voluntarily assume all such risks, loss, damages, or injury that may be sustained by my
presence, and the presence of my dog(s), at the park.
By signing this release of liability, I hereby fully and forever release and discharge the City
of Iowa City, the Parks and Recreation Department, and Johnson County Dog Park Action
Committee and their volunteers, employees, and agents from any claims, demands,
damages, rights of action or causes of action, present or future, whether the same be
known or unknown, anticipated or unanticipated, resulting from or arising out of my use
or intended use of Iowa City Off-Leash Dog Parks. I fully and forever release and discharge
City of Iowa City, the Parks and Recreation Department, and Johnson County Dog Park
Action Committee, their volunteers, employees, and agents, from any and all negligent
act and omissions in the same.
By signing this agreement, I also agree to indemnify the City of Iowa City, the Parks and
Recreation Department, Johnson County Dog Park Action Committee, their volunteers,
employees, and agents from any claims, demands, damages, rights of action or causes of
action present or future whether the same be known or unknown, anticipated or
unanticipated, brought against any or all of such entities based on my use or intended use
of the Iowa City Off-Leash Dog Parks.
I have carefully read this Release of Liability and Indemnification Agreement and
understand and fully agree with its terms.
This is a release of liability.
Do not sign if you do not understand or do not agree with its terms. Signature is
required to obtain a permit and to use the park.
x
Print Name
x x
Signature Date