Dog Park - Membership Application

Dog Park Membership

Application
Please complete and submit this application to be considered for membership in the Irmo Dog Park at Rawls Creek Park. Submission of the application does not guarantee acceptance into the Irmo Dog Park.

Membership Fees:
- First Dog - $25
- Each Additional Dog - $15
All dogs must be spayed/neuterd and have current vaccinations for rabies, bordatella, and DHPP.

By submitting this application, you are acknowledging that you have read and understood the rules of the Irmo Dog Park. If you are unable or unwilling to comply with these rules, your membership may be suspended or revoked.
Applicant Name*

First NameLast Name
Applicant Email*
example@example.com
Applicant Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please enter any notes about your dog(s), such as whether they are young, low weight dogs that will soon be large dogs.
Dog 1
Dog 1 Name*
Dog 1 Breed*
Dog 1 Weight (lbs)*
FemaleMale
Dog 1 Spay/Neuter Date

MonthDayYear
Date, if available
Dog 1 Rabies Vaccination Expiration Date*

MonthDayYear
Date
Dog 1 Bordatella Vaccination Expiration Date*

MonthDayYear
Date
Dog 1 DHPP Vaccination Expiration Date*

MonthDayYear
Date
Dog 1 Veterinarian Records

Please upload current vaccination records and, if available, proof of spay/neuter
Cancelof
Dog 2

Optional
Dog 2 Name
Dog 2 Breed
Dog 2 Weight (lbs)
FemaleMale
Dog 2 Spay/Neuter Date

MonthDayYear
Date, if available
Dog 2 Rabies Vaccination Expiration Date

MonthDayYear
Date
Dog 2 Bordatella Vaccination Expiration Date

MonthDayYear
Date
Dog 2 DHPP Vaccination Expiration Date

MonthDayYear
Date
Dog 2 Veterinarian Records

Please upload current vaccination records and, if available, proof of spay/neuter
Cancelof
Dog 3

Optional
Dog 3 Name
Dog 3 Breed
Dog 3 Weight (lbs)
FemaleMale
Dog 3 Spay/Neuter Date

MonthDayYear
Date, if available
Dog 3 Rabies Vaccination Expiration Date

MonthDayYear
Date
Dog 3 Bordatella Vaccination Expiration Date

MonthDayYear
Date
Dog 3 DHPP Vaccination Expiration Date

MonthDayYear
Date
Dog 3 Veterinarian Records

Please upload current vaccination records and, if available, proof of spay/neuter
Cancelof
Dog 4

Optional
Dog 4 Name
Dog 4 Breed
Dog 4 Weight (lbs)
FemaleMale
Dog 4 Spay/Neuter Date

MonthDayYear
Date, if available
Dog 4 Rabies Vaccination Expiration Date

MonthDayYear
Date
Dog 4 Bordatella Vaccination Expiration Date

MonthDayYear
Date
Dog 4 DHPP Vaccination Expiration Date

MonthDayYear
Date
Dog 4 Veterinarian Records

Please upload current vaccination records and, if available, proof of spay/neuter
Cancelof
Signature*

Clear
By signing, I acknowledge that all information is true and complete, and that I have read and understand the rules of the Rawls Creek Dog Park.
Should be Empty:

Dog Park Membership

Dog 1

Dog 2

Dog 3

Dog 4