General Information

Owner:    

Telephone-Home:    Cell:

Address:     City:     State:     Zip:

Contact e-mail:

Vet Clinic:     Telephone:     

Emergency Contact:     Number:

Referred to Genesee Pet Suites by:

Preferred Type of Boarding:      Kennel:      Suite:      

Requesting Boarding Dates:      From:       To:

Complete the following:

If more than one animal, complete information for each animal on separate forms and check box below.

More than one animal

Dog's name:     Breed:     Color:     Birthday:

Sex: Male Female     Normal Diet-Canned Food:     Dry Food:

Number of Daily Feedings:      Amount per Feeding:

Immunization Record

Rabies Due:     DHLPP Due:     Bordatella Due:

Are there any allergies/describe:    

Anything contagious:

Medication:     Describe:

Has your dog had obedience training? Choose One Yes No   

 Is this the first time in a kennel? Choose One Yes No

Has your dog ever growled or snapped at anyone? Choose One Yes No

If so describe circumstances: 

Are there any behavior problems or idiosyncrasies we should be aware of for the comfort and safety of your dog and his handlers?

Agreement

I certify that my dog(s) is in good health, except as noted above, and has not been ill with any communicable diseases in the past 30 days; furthermore I understand and agree that in admitting my dog(s) to Genesee Pet Resort LLC, GPR LLC has relied on my representation that my dog(s) has not harmed or shown aggressive or threatening behavior towards any person or other dog accept as noted above.

I certify my animal has been neutered.

I grant GPR LLC and its agents full power of decisions concerning the care and will being of my dog(s). Should any medical emergency arise, it is agreed that GPR LLC or its agents can and will make any needed decisions concerning medical treatment and choices of caregiver up to $ which I accept full responsibility for payment.

Signature:     Date:

Genesee Pet Suites LLC will respond to your application request in no more than about 48 hours.