Membership Form - Club K9 Dog Bar

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Primary Member Gender*

Male
Female
Prefer not to say

Primary Member Date of Birth*

MM/dd/yyyy

Primary Member Age*

Dogs

Membership Type

How many dogs do you want to include in your Membership?*

At this time, we are not accepting more than 3 dogs per household. We are sorry for this inconvenience!

Dog 1

First Dog's Name*

First Dog's Primary Breed*

First Dog's Secondary Breed

First Dogs Gender*

First Dog's Birthday*

Who is your Veterinarian for this dog?*

Is this dog spayed/neutered?*

Yes
No

Is this dog currently on vaccinations for Rabies, DHLPP and Bordetella?*

Yes
No

Is this dog on monthly heartworm prevention?*

Yes
No

Has this dog been properly socialized for group play?*

Yes
No

Dog #1 Proof of Vaccinations*

Max. file size: 256 MB.

Dog 2

Second Dog's Name*

Second Dog's Primary Breed*

Second Dog's Secondary Breed

Second Dogs Gender*

Second Dog's Birthday*

Who is your Veterinarian for this dog?*

Is this dog spayed/neutered?*

Yes
No

Is this dog currently on vaccinations for Rabies, DHLPP and Bordetella?*

Yes
No

Is this dog on monthly heartworm prevention?*

Yes
No

Has this dog been properly socialized for group play?*

Yes
No

Dog #2 Proof of Vaccinations*

Max. file size: 256 MB.

Dog 3

Third Dog's Name*

Third Dog's Primary Breed*

Third Dog's Secondary Breed

Third Dogs Gender*

Third Dog's Birthday*

Who is your Veterinarian for this dog?*

Is this dog spayed/neutered?*

Yes
No

Is this dog currently on vaccinations for Rabies, DHLPP and Bordetella?*

Yes
No

Is this dog on monthly heartworm prevention?*

Yes
No

Has this dog been properly socialized for group play?*

Yes
No

Dog #3 Proof of Vaccinations*

Max. file size: 256 MB.

Consent*

I understand and agree to Louisville Dog Bar's Terms and Conditions and Park Rules.

Email

This field is for validation purposes and should be left unchanged.