Bridesburg "Bark Park" - Dog Park Membership Interest Form
The Bridge Clinic is collecting information for those that are interested in being members of Bark Park in Bridesburg, Philadelphia, PA.

Please provide an email address that is REGULARLY monitored, as that will be the primary mode of communicating updates about Bark Park!
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First Name *
Last Name *
Phone Number *
Email Address *
Street (include house number) *
Apt/Unit Number (if applicable)
City *
State *
Zip Code *
How many dogs do you have/want to register for Bark Park? *
Please list the name(s) of your dog(s). *
Please list the weight(s) of your dog(s). *
Estimated date(s) of birth for your dog(s). *
Please list the breed(s) of your dog(s). *
Are all of your pets up-to-date on ALL of the vaccines listed below: 

Rabies, Distemper (aka DHPP or DAPP, including parvo), Bordetella. Leptospirosis is recommended, but not required.
 *
Are all of your pets spayed or neutered? Please note, this is a requirement for dog park membership. *
Do any of your pets have any known behavioral issues? (Note: dogs with behavioral issues may be a candidate for our "single dog" entry area). *
Name and phone number of your pet's current veterinary office. *
Do any of your pets have any known medical issues? If so, please disclose below:
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