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 Vaccination Records from your Veterinarian or have them fax it to us at (734) 433-1444 Vaccinations include: Rabies, distemper combination, Bordetella (kennel cough), Leptospirosis & Canine Influenza Virus (CIV)H3N2 & H3N8(Canine Flu). We suggest a negative heartworm check and some kind of flea protection when coming to Animal Camp. Veterinarian*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 This iframe contains the logic required to handle Ajax powered Gravity Forms.