Membership Form Membership Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Member Gender* Male Female Prefer not to say Primary Member Date of Birth* MM/dd/yyyyPrimary Member Age* DogsMembership TypeDailyMonthlyYearlyHow 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 1First Dog's Name* First Dog's Primary Breed* First Dog's Secondary Breed First Dogs Gender*-Select-MaleFemaleFirst Dog's Birthday* MM slash DD slash YYYY 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 2Second Dog's Name* Second Dog's Primary Breed* Second Dog's Secondary Breed Second Dogs Gender*-Select-MaleFemaleSecond Dog's Birthday* MM slash DD slash YYYY 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 3Third Dog's Name* Third Dog's Primary Breed* Third Dog's Secondary Breed Third Dogs Gender*-Select-MaleFemaleThird Dog's Birthday* MM slash DD slash YYYY 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.CommentsThis field is for validation purposes and should be left unchanged.
