Personal Information

First Name:

Last Name:

Address:

City:

State:

Zip:

Phone Home

Phone Work

Cell Phone

Fax

E-mail

 Emergency Contact Information

Emergency Contact 1

Name & Number

Emergency Contact 2

Name & Number2

How did you hear about us?

Guest Information

Dog’s Name

Dog’s Birthday

Dog’s Breed

Dog’s Sex

Male Female

Dog’s Age

Dog’s Color

Second Dog’s Name

Second Dog’s Sex

Male Female

Second Dog’s Age

Second Dog’s Color

Second Dog’s Birthday

Second Dog’s Breed

Vet Information

Vet’s name

Vet’s address

Vet’s city, state, zip

Vets phone number

Vets fax number

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Shot records must be received at Waggin’ Tails prior to check-in.

Boarding

Date for Check In

Time for Check In

Date for Check Out

Time for Check Out

Special Information

Spayed/Neutered yes/no

Yes No

Flea Program yes/no

Yes No

Bath dog before check out yes/no

Yes No

Special Requests

Medications taken

Obedience commands known

Behavior problems

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New Customers go to Submit Button

SHORT FORM - Existing Customers (only)

First Name

Last Name

Date for Check In

Time for Check In

Date for Check Out

Time for Check Out

All customers click Submit->