New Boarding Client Form Client InformationPlease provide the information below as completely as possible. All information is strictly confidential. If your reservation is for a holiday or around a holiday please call for reservationsName* First Last Email* Home Phone*Work PhoneCell PhoneAddress* 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 Pet InformationPet's Name*Pet's Breed*Pet's Weight*New Boarder? Yes No Name of Flea/Tick Prevention*(must have TICK prevention)Flea/Tick Prevention Date Applied Additional InfoType of Kennel:*CabanaCottageThunder SuiteUpper SuiteStandard (Under 50#’s )Standard (Over 50#’s )Groom*YesNoBath*YesNoGroup Play*YesNoPaw Pops (Frozen Yogurt Treats)*YesNoHow Many Paw PopsIndividual Play*YesNoHow Many Times Per Day (Individual Play)Group Pool*YesNoIndividual Pool*YesNoHow Many Times Per Day (Individual Pool)Special NotesBrand of food & feeding instructions:(please bag food for each individual serving in a zip lock baggie)Number Of BagsMedical ProblemsName of your VeterinarianVeterinarian phone numberDates of BoardingDrop Off Date* Approx. Drop Off Time : HH MM AMPM Pick Up Date*after 2:00 pm if having groom/bath (If picking up Sat at 3:00 pm or Sun at 8:00 am or 3:00 pm- must be PREPAID) *Note: We will contact you with availability for the dates you have requested.Emergency Contact InformationContact Name and NumberContact Name and NumberMedications and Special InstructionsPlease list special conditions, medications, dosage, frequency, etc.Being away from home can be a stressful experience for some pets. I give permission for treatment and assume payment if my pet becomes ill while boarding.I Agree to the terms above:* Yes Additional QuestionsPlease read and signI understand that if my pet enters the Pet Resort with fleas or ticks that it will be treated at my expense. All vaccinations must be current within 1 year and Bordetella within 6 months. In case of emergency or illness I authorize the veterinarian to treat my pet using our veterinarian and I am responsible for all charges. If medications are necessary for treatment I give my permission to administer such medications.Fax over your records to 239-482-7922 or email: email@example.com Client Signature*Emergency Phone*CAPTCHAEmailThis field is for validation purposes and should be left unchanged.