Dates you are requesting:
Dog's Name:
(If more than one dog please submit another form)
Sex:
Breed:
Size (in pounds):
Your Name:
Address:
Telephone:
Cell Phone or Beeper:
Email Address:
Emergency Contact
(name and telephone #):
Number where you can be reached while you're away:
Veterinarian Info:
Name,
Address, &
Telephone:
Is your dog current with the following required vaccines?
Is your dog currently protected for fleas and ticks, i.e. Frontline, Advantage?
Please note that we cannot accept any dog with fleas or ticks!!!
Has your dog been neutered or spayed?
Should we be aware of any medical conditions that your dog has?
(If yes, please explain)
Is your dog people-friendly?
(If not, please explain)
Does your dog get along with other dogs?
(If not, please explain)
What brand of dog food does your dog eat?
Feeding times:
Amount of food:
Additional Comments:
