Lake Country Dog

Day Care/Boarding/Grooming Contract

Lake Country Dog
Day Care/Boarding/Grooming Contract

All pets scheduled for day care and/or boarding services MUST have the following form completed and submitted to us PRIOR to their appointment. By submitting this form and admitting my pet to Lake Country Dog for boarding and/or day care, I agree to the terms and conditions outlined below.

Items marked with an asterisk (*) are required

Your Name:*  

Your Email:*  

Home Phone:* Work Phone:*

Cell Phone:*  

Address:*      

City:*     State: Zip:

Drop Off Date:* Drop Off Time:

Pick Up Date:*   Pick Up Time:

Emergency Contact:*   Phone Number:

I will be providing a (key, garage code, other, or N/A):*    

When dropping off I would like them left (kennel, specific room, out free, etc):*    

VET INFORMATION

Vet Name/Office:*       Phone Number:

Vet Address:

PET INFORMATION (Pet #1)

Pet's Name:*

Pet's Age:* Pet's Weight:* Pet's Gender:*

Pet's Breed:*

Spayed/Neutered?*  No Yes       Microchipped?*  No Yes       Chip number:

MEDICAL / VACCINATION HISTORY (Pet #1)

Indicate expiration for vaccinations below:

Rabies:* DHLPP:* Bordatella:*

Current Medicactions:

Reason for Medication

Medication Instructions

Important Medical History Notes

Feeding Instructions

Special Instructions

PET INFORMATION (Pet #2 optional)

Pet's Name:

Pet's Age: Pet's Weight: Pet's Gender:

Pet's Breed:

Spayed/Neutered?  No Yes       Microchipped?  No Yes       Chip number:

MEDICAL / VACCINATION HISTORY (Pet #2)

Indicate expiration for vaccinations below:

Rabies: DHLPP: Bordatella:

Current Medicactions:

Reason for Medication

Medication Instructions

Important Medical History Notes

Feeding Instructions

Special Instructions

PET INFORMATION (Pet #3 optional)

Pet's Name:

Pet's Age: Pet's Weight: Pet's Gender:

Pet's Breed:

Spayed/Neutered?  No Yes       Microchipped?  No Yes       Chip number:

MEDICAL / VACCINATION HISTORY (Pet #3)

Indicate expiration for vaccinations below:

Rabies: DHLPP: Bordatella:

Current Medicactions:

Reason for Medication

Medication Instructions

Important Medical History Notes

Feeding Instructions

Special Instructions

By submitting this form, and checking the acceptance box below with my digital signature and today's date, I am agreeing to the terms above and to the fees associated with boarding/day care at Lake Country Dog, as outlined in this website.

Name: Date:

Type the characters shown below:
captcha

Share it!