Client Information Please provide the information below as completely as possible. All information is strictly confidential.If your reservation is for a holiday or around a holiday please call for reservations Name * First Last Email * Home Phone * Work Phone Cell Phone Address * Street Address Address Line 2 City Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah U.S. Virgin Islands Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Pet Information Pet's Name * Pet's Breed * Pet's Weight * New Boarder? Yes No Second Pet's Name Second Pet's Breed Second Pet's Weight New Boarder? Yes No Dates of Boarding Drop Off Date * MM slash DD slash YYYY Pick Up Date * MM slash DD slash YYYY *Note: We will contact you with availability for the dates you have requested. Emergency Contact Information Contact Name and Number Contact Name and Number Additional Services *Note: Charges will apply for additional services. Medications and Special Instructions Please list special conditions, medications, dosage, frequency, etc. Being away from home can be a stressful experience for some pets. I give permission for treatment and assume payment if my pet becomes ill while boarding. I Agree to the terms above: * Yes Additional Questions If you have more than one dog. Would you like them to stay together? Please read and sign I understand that if my pet enters the Pet Resort with fleas or ticks that it will be treated at my expense. All vaccinations must be current within 1 year and Bordetella within 6 months. In case of emergency or illness I authorize the veterinarian to treat my pet using our veterinarian and I am responsible for all charges. If medications are necessary for treatment I give my permission to administer such medications. Client Signature * Emergency Phone * Comments This field is for validation purposes and should be left unchanged.
