Enrollment Application

Please Note:  All dogs must be wearing a quick-release collar, have up to date vaccination records, and successfully complete our application and meet and greet evaluation.  Dogs over six months of age must

be spayed or neutered.

 

OWNER’S INFORMATION

 

NAME:_________________________________________________________________

 

ADDRESS:______________________________________________________________

 

PHONE(Home):________________________(Work)_____________________________

            

              (Cell):_________________________(e-mail)___________________________

 

OTHER THAN YOURSELF WHO IS AUTHORIZED TO PICK UP YOUR DOG?

 

________________________________________________________________________

 

HOW DID YOU HEAR ABOUT US?____________________________________________

 

DOG’S INFORMATION

 

NAME:___________________________BREED________________________SEX____

 

AGE:__________WEIGHT OF DOG (in lbs)_______________BIRTH DATE____________________

 

SPAYED/NEUTERED_____

 

VETERINARIAN

 

NAME:_________________________________________________________________

 

ADDRESS:______________________________________________________________

 

PHONE:________________________________________________________________

 

EMERGENCY CONTACTS

 

NAME:____________________________PHONE_____________________________

 

NAME:____________________________PHONE_____________________________