New Boarding Client Form Client InformationPlease 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 reservationsName* First Last Email* Home Phone*Work PhoneCell PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Pet InformationPet's Name*Pet's Breed*Pet's Weight*New Boarder? Yes No Name of Flea/Tick Prevention*(must have TICK prevention)Flea/Tick Prevention Date Applied MM slash DD slash YYYY Additional InfoType of Kennel:*CabanaCottageThunder SuiteUpper SuiteStandard (Under 50#’s )Standard (Over 50#’s )Groom* Yes No Bath* Yes No Group Play* Yes No Paw Pops (Frozen Yogurt Treats)* Yes No How Many Paw PopsIndividual Play* Yes No How Many Times Per Day (Individual Play)Group Pool* Yes No Individual Pool* Yes No How Many Times Per Day (Individual Pool)Special NotesBrand of food & feeding instructions:(please bag food for each individual serving in a zip lock baggie)Number Of BagsMedical ProblemsName of your VeterinarianVeterinarian phone numberDates of BoardingDrop Off Date* MM slash DD slash YYYY Approx. Drop Off Time : Hours Minutes AMPM AM/PMPick Up Date*after 2:00 pm if having groom/bath MM slash DD slash YYYY Pick up is Sat or Sun either 8 AM or 5 PM at the right side of the building. - must be PREPAID*Note: We will contact you with availability for the dates you have requested.Emergency Contact InformationContact Name and NumberContact Name and NumberMedications and Special InstructionsPlease 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 QuestionsPlease read and signI 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.Fax over your records to 239-482-7922 or email: tailsawagginanimalhospital@comcast.net Client Signature*Emergency Phone*CAPTCHANameThis field is for validation purposes and should be left unchanged.
