The Park Pet Retreat » Registration Form

Pooch Parent Information:

Name:

Address:

City:

State:

Zip:

Phone: (H)

(W)

Cell:

E-mail address:

How did you hear about us?

Pooch Information:

Dog's Name

Breed

Color

Sex

Age (please include birthday)

Veterinarian Information:

Name:

Address:

City:

State:

Zip

Phone:

Emergency Contact (other than vet):

Name:

Address:

City:

State:

Zip

Phone (H):

(W)

Cell:

Are any other Persons allowed to Pick-up your Dog? If so, who: 1.
2.
3.

All dogs over 7 months of age must be Spayed or Neutered.

Spayed / Neutered?

Date:

Micro-Chipped?

Other Identification?

PLEASE NOTE:
It is necessary for your Pet to be current on the following vaccinations for the services requested.
*Boarding: Rabies, Bordatella (Kennel Cough), DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus)
*Daycare: Rabies, Bordatella (Kennel Cough), DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus)
*Respite Care: Rabies, Bordatella (Kennel Cough), DHPP (Distemper, Hepatitis, Parainfluenza, Parvovirus)
*Grooming: Rabies
*Basic Bath: Rabies

Please indicate the SERVICES & DATES you need. We will be in contact with you to Confirm availability.

Boarding

Date From:

Date To:

Daycare

Dates

Respite Care

Dates

Grooming

Dates

Basic Bath & Nails

Dates
Self-Serve Bath is first-come, first-served

Medical History:

Current Medication:

Special Instructions: