Country Meadows Boarding Pet profile form

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Country Meadows Boarding Pet profile form Powered By Docstoc
					                               Country Meadows Boarding
                                    Pet profile form
                             Please Fax the following at: (450) 451-0052



OWNER INFORMATION

First Name:
Last Name:
Email:
Address:
City:
Province:
Postal Code:
Home Phone:
Work Phone:
Cell Phone:
Emergency Contact Name:
Emergency Contact Phone:
Credit Card Information
       Type of card (visa or MasterCard):
       Credit Card number:
       Expiry date:
       Name on the Card:




PET INFORMATION

Cat/Dog:
Call Name:
Breed:
Male/Female:
Neutered/Spayed/Neither:
Weight:
Color/Description:
Your pet’s language for basic commands:
Age (in human years):
Birth date (mm/dd/yy):
Is Pet Aggressive and/or Non-Social:



We do not discriminate against any breed, but we do express a concern about fighting breeds
and/or aggressive dogs. We try to socialize dogs as much as possible, and their safety is our
number one concern. We need to know in advance whether your pet will get along during group
activities.



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                                 Country Meadows Boarding
                                      Pet profile form


MEDICAL INFORMATION

Allergies/Serious Conditions:
Medications Required:
Vet Clinic name:
Vet name:
City:
Phone:
Comments:
Current proof of vaccinations:

CANINE

D.A2.P.PV. (current annual)
Given (mm/dd/yy):
Due (mm/dd/yy):

Rabies:
Given (mm/dd/yy):
Due (mm/dd/yy):

Bordetella (kennel cough):
Given (mm/dd/yy):
Due (mm/dd/yy):

Leptospirosis:
Given (mm/dd/yy):
Due (mm/dd/yy):

FELINE
F.V.R.C.P. (current annual)
Given (mm/dd/yy):
Due (mm/dd/yy):

Rabies:
Given (mm/dd/yy):
Due (mm/dd/yy):

Current type of flea prevention program:



Flea prevention is mandatory between May and October. Please be sure to supply medication and
we will administer it at no charge if it is required during the stay. If upon check-in your pet is found
to have fleas, a flea bath will be given at your expense.

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posted:3/30/2010
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