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Lucky Dog POOCH PASS Application

Date for start of membership:
Membership Type:  Indoor Training Room
  Outdoor Agility Field
  Full Membership (Both)
Duration of Membership: Monthly* 3 Month 6 Month 12 Month
*Name of Human Partner(s):
Address:

City:

State: Zip:
Home Phone: Cell Phone:
Work Phone:
*E-mail Address:
Dog's Name:
Color: Breed:
Birthdate: Sex:
 Date last given:
Distemper / Parvo:
 
Bordetella:
 
Rabies:
 
Fecal:
List any behavioral problems:
Additional Dog's Name:
Color: Breed:
 Birthdate: Sex:
 Date last given:
Distemper / Parvo:
 
Bordetella:
 
Rabies:
 
Fecal:
List any behavioral problems:
Additional Dog's Name:
Color: Breed:
 Birthdate: Sex:
 Date last given:
Distemper / Parvo:
 
Bordetella:
 
Rabies:
 
Fecal:
List any behavioral problems:
How did you hear about us?
If Friend or Other please specify:
Other Information / Comments:
Payment Details
Amount of Dues (must be paid in full): + $25.00 Pooch Pass (of which $15 is refundable when returned in excellent condition)
Total Amount:
Payment Method: Cash Check Credit Card
(Fill in below for faster service)
Card Number:
Exp.
Name on Card:
Billing Address:
( if different from above)

City:

State: Zip:
I authorize Lucky Dog Sports Club to charge my credit card (if paying this way). Please enter your initials

Membership Process: After we receive your application we will mail you (or you can choose to pick up) your non-activated Pooch Pass electronic access card. You must contact us by phone or email upon receipt. We will then
activate your Pooch Pass so that you have full access to the appropriate doors and gates. Please allow one to two weeks for your membership to become active after we have received your application,though in most cases it
can be done within a few days.
Your pass will expire at the end of your membership period unless you reactivate by payment of the desired term.

*Note: Membership always begins on the first day of the month for ease of renewal. If you join later than the first day of a month and want to begin immediately, you will be charged by the day for the balance of the first month, and then for the next complete period. The prorated daily rate is based on the type and length of membership you have chosen.

Refunds / cancellation: There is no refund if membership is cancelled. Membership is not transferable to a different person.

*I have read and understand the release and waiver of claims. of this agreement. Please enter your initials

*I have read and understand the Rules for Membership.
Please enter your initials


 
 

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