Wufoo

Citizen Canine New Client Registration

Today's Date / MM / DD YYYY
Primary Guardian First Last
Secondary Guardian First Last
Primary Home Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Email Address
Home Phone - (###) - ### ####
Work Phone - (###) - ### ####
Mobile Phone - (###) - ### ####
Preferred Contact Number Home Phone Work Phone Mobile Phone
Emergency Information

Please give us the name and details for a family member or close friend who is the emergency contact in the event we cannot reach you.
Emergency Contact First Last
Please give us the name and details for a family member or close friend who is the emergency contact in the event we cannot reach you.
Emergency Contact Phone - (###) - ### ####
Veterinarian/Clinic Name
Veterinarian/Clinic City
Veterinarian/Clinic Phone - (###) - ### ####
Requested Services

This form DOES NOT book your pet's stay.
Your reservation will not be confirmed until one of our customer service contacts you.
I am interested in scheduling my dog for: Day Care Overnight Boarding
Please check all that apply.
I would like to drop my dog off on: / MM / DD YYYY
I would like to pick my dog up on: / MM / DD YYYY
If boarding more than one dog, they should share a single family size room. stay in separate rooms.
Dog 1 Information

Your dog's details.
Dog 1 Name
Dog 1 Age
Dog 1 Breed / Color
Dog 1 Approximate Weight (lbs)
Dog 1 Gender Female Female (Spayed) Male Male (Neutered)
Has your dog ever boarded before?
Is your dog comfortable meeting new people?
Has your dog ever bitten a person?
Is your dog social with other dogs?
Has your dog ever been in a fight with another dog?
Dog 2 Information

If you have a SECOND animal staying with us, please fill their details in here.

If not, please leave it blank, but don't forget to click the SUBMIT BUTTON at the bottom of the form to send us your information!
Dog 2 Name

A description of the section goes here.
Dog 2 Age
Dog 2 Breed / Color
Dog 2 Approximate Weight (lbs)
Dog 2 Gender Female Female (Spayed) Male Male (Neutered)
Has your dog ever boarded before?
Is your dog comfortable meeting new people?
Has your dog ever bitten a person?
Is your dog social with other dogs?
Has your dog ever been in a fight with another dog?
Dog 3 Information

If you have a THIRD dog staying with us, please fill their details in here.

If not, please leave it blank, but don't forget to click the SUBMIT BUTTON at the bottom of the form to send us your information!
Dog 3 Name

If you have a THIRD animal staying with us, please fill their details in here.
Dog 3 Age

If you have a THIRD animal staying with us, please fill their details in here.
Dog 3 Breed / Color

If you have a THIRD animal staying with us, please fill their details in here.
Dog 3 Approximate Weight (lbs)

If you have a THIRD animal staying with us, please fill their details in here.
Dog 3 Gender Female Female (Spayed) Male Male (Neutered)
If you have a THIRD animal staying with us, please fill their details in here.
Has your dog ever boarded before?
Is your dog comfortable meeting new people?
Has your dog ever bitten a person?
Is your dog social with other dogs?
Has your dog ever been in a fight with another dog?
Referral
How did you hear about us? Vet Friend Professional Internet Other
Do Not Fill This Out

Wufoo

Citizen Canine New Client Registration

Emergency Information

Requested Services

Dog 1 Information

Dog 2 Information

Dog 3 Information

Referral