Gracious Kennels Ranch and Spa
Dogs Name: ____________________________________________________________
Owner’s Name: _________________________________________________________
Owner’s Address: _______________________________________________________
City: ___________________________ State: ______________ Zip: ___________
Home Phone: _______________ Alt:_______________________
Emergency Contact: ________________________ Phone: _________________
Proof of vaccinations and a current fecal exam within the last 3 months, is required prior to or at the time of boarding. In order to provide better protection for your pet, all vaccinations should be given at least 1 to 2 weeks prior to boarding.
DHLP: ____________________________ Parvo: _____________________________
Bordetella (within 1 year): ________________________________________________
Rabies (within 3 years): _________________________________________________
What breed or mix is your dog? ___________________________________________
What is your dog’s age? ___________________ Sex: £ Male £ Female
Does your dog have any medical or physical problems? £ Yes £ N
If yes, please explain: ____________________________________________________
______________________________________________________________________
Do we need to administer any medications during your dog’s stay with us?
£ Yes £ No
If yes, please list the medication and dosage: ________________________________
Is your dog been spayed/neutered? £ Yes £ No
Has your dog ever been aggressive towards humans? £ Yes £ No
If yes, please explain: ____________________________________________________
_____________________________________________________________________
Has your dog ever been aggressive towards other dogs? £ Yes £ No
If yes, please explain: ____________________________________________________
_____________________________________________________________________
In case your dog should need medical attention during their stay, we have permission to take emergency action, if necessary, and the liability for any fees incurred will be on the owner. Please provide the name and phone number of your veterinarian
Name: _____________________________ Phone: _____________________________
Do you want your dog to have free range? £ Yes £ No
If so, even though all activity is supervised, we want you to understand that during the course of play, they may possibly be injured
Gracious Kennels is not responsible for any accident or injury that may be incurred by your dog during their stay at the facility. We will make every effort in our expertise to make sure that your dog is safe at all times and that someone will always be supervising them.
______________________________________ Signature of Owner ______________________________________ Signature of Kennel Employee
Check In : Date : _______________________ Time : _______________________
Check Out : Date : _______________________ Time : _______________________
