Pooch Pass Application
Donna Lent, Town Clerk rev. 6/20
Patricia Ryan-Correa, Chief Deputy Town Clerk
One Independence Hill, Farmingville, NY 11738
(631) 451-9101 FAX: 451-9264
Applicants should mail the completed application and 1”x1” photograph(s) of dog(s) to be named on the
Pooch Pass. The pass will be valid from May 1
st
through April 30
th
. Parks are open from 8:00 AM to
Dusk, 7 days a week. There are abbreviated hours during holidays. Replacement Pass Fee: $15.00
Middle Island Dog Park Selden Dog Park
N of Rte 25, W of Woodville Rd West Side of Boyle Rd
E of Currans Rd, S of Whiskey Rd, Middle Island Across from Donna Ct, Selden
RULES AND REGULATIONS
Handlers must clean up after their pet.
Dogs with a known history of dangerous behavior and female dogs in heat are prohibited.
Dogs must have current vaccinations and licenses.
Dog must be wearing a collar with current dog license.
Puppies under four (4) months old prohibited.
Dogs must be spayed or neutered.
Leaving dogs unattended is prohibited.
Handlers must carry a leash at all times.
Limit two (2) dogs per person per visit.
Dogs must be leashed prior to entering and upon leaving area.
Dog owners and dogs must stay within the designated park area.
Dog must be removed from the park at the first sign of aggression.
No children under the age of 12 allowed in off-leash area.
No food, drink, or smoking allowed.
No choke or prong collars allowed.
No balls or toys permitted.
Dog owners must be at least 18 years old.
Owners and/or handlers are responsible for their dog’s actions.
You must pick up after your dog and place excrement in receptacles by each gate.
Any dogs outside this area must be on a leash (six foot long maximum).
Town of Brookhaven and New York State residents only are permitted in the park.
The above captioned Rules and Regulations were approved by the Brookhaven Town Board for the permitted use
of Dog Parks within the Town of Brookhaven pursuant to Town Code 10-15.1. If a secondary person is on the dog
pass they are required to read and have a copy of the rules and regulations.
______ I have read these rules and understand that violating any of these rules will result in the termination of
Initial my Dog Park privileges.
RELEASE AND HOLD HARMLESS DOG PARK PERMIT
The undersigned in being granted a permit for the use of Town property and/or Town facilities hereby agrees to assume all
liability and all risk of loss and shall be responsible for the supervision and welfare of all persons and/or pets arriving on and/or
using Town property and/or facilities in connection with permit issued. The undersigned further hereby releases the Town of
Brookhaven, its officers, employees, servants, agents and enumerated volunteers from any liability for any injuries sustained,
or damages incurred and to reimburse the Town for any damages arising out of directly or indirectly in connection with the
undersigned’s use of the Town property and/or facilities. The undersigned hereby further agrees that he/she will indemnify and
hold harmless the Town of Brookhaven, its officers, employees, servants, agents and enumerated volunteers harmless from any
liability or claims that may result from the use of the Town property and/or facilities arising out of said permit.
Applicant’s Name: ______________________________________________
Signature of Applicant: __________________________________________ Date: ________________________
