Dog Registration

Dog's Name: *

Today's date: *

Owner's Name *

First

Last

Alternate (Owner) Contact: *

First

Last

Preferred Phone Number To Reach You: *

Alternate Phone Number *

Address Line 1: *

City: *

Address Line 2 *

Province *

Emergency Contact Name: *

First

Last

Please provide the names of family members allowed to pick up your dog: *

Emergency Contact Phone Number *

Name of Veternarian Clinic you use: *

Veternarian Clinic Phone Number: *

Breed of your dog *

Age of your dog: *

Spayed/Neutered *

Yes No

Dog's Gender: *

Male Female

Colouring/Markings on your dog: *

Allergies: *

Please provide details if your dog has health concerns *

Does your dog require medication? *

Yes No

If yes, please provide instructions for medication *

Is your dog on a Flea or Tick preventative? *

Yes No

When was the last dosage for Flea/Tick prevention? (mm/yy) *

What are your dog's preferred feeding times: *

Breakfast Lunch Supper Leave Food available all day

Please provide feeding instructions *

List of dog's personal belongings he/she will be bringing: *

Date of last Rabies shot (dd/mm/yy) *

Date of last Distemper shot (dd/mm/yy) *

Date of last Bordetella (kennel cough) shot (dd/mm/yy) *

Date of last Parvovirus shot (dd/mm/yy) *

The undersigned each hearby acknowledges that Terry Jenkins and TJ Stables and their employees are in no way responsible or liable for any injuries or property damage sustained while your dog/pet is on the premises or utilizing the facilities, nor are the owners of the property itself in any way responsible or liable for such injury or damage. I understand that I am responsible for any costs that may be incurred by my pet. I hearby release Terry Jenkins, TJ Stables and their employees and the property owners from any and all liabilities, past, present or future. *

I Accept

DOG REGISTRATION

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