Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Home Phone*Cell Phone*Dog's Name*Dog's Breed*Dog's Color*Dog's Sex*Please SelectMaleFemaleIs your dog spayed or neutered?YesNoDog's Birthdate* Date Format: MM slash DD slash YYYY Please bring a copy of updated Vaccinations Record from your Veterinarian or email them to us at info@animalcampboarding.com Vaccinations include: Rabies, Distemper combo or copy of titers, Bordetella. Canine Influenza Virus is Reccomended. We suggest a negative heartworm check Fleas & Tick Control - Please have your pet on some kind of program. We do take dogs outside to the grass yard. Please check with your Veterinarian for the best program for your petVeterinarian*Vet's Phone*Feeding InstructionsCan your dog have treats?*Please SelectYesNoAre there any treats your pet can not have?Is your pet on any medication?*Please SelectYesNoIf Yes, what kind of medication?This medication is for treating what kind of health problem?How is this medication given & how often?(If you use bread, peanut butter, cheese, or need gauze or other for this med., please bring this along to Animal Camp with your pets medicine.) Exercise Information: Does your dog have any exercise restrictions?*Please SelectYesNoCan your dog(s) go to the play yard with other dogs?*Please SelectYesNoCan your dog(s) get dirty?*Please SelectYesNoSpecial Instructions