Sirius Canines
Registration Form
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (mobile Preferred)
*
-
Phone Number
Dog Name
*
Dog Breed
*
Dog Gender
*
Male
Female
What is your dogs date of birth?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is Your Dog Desexed (just so we know)
Yes
No
Which days would you prefer for daycare?
*
Tuesdays
Wednesday
Thursday
Friday
Monday
Who is your current vet?
*
Is your dog on any medications, or have health issues we need to be aware of?
*
Please upload a photo/scan of your dogs current vaccination records
Browse Files
Drag and drop files here
Choose a file
Alternatively, you can bring your records along with you when you come for your visit
Cancel
of
How did you hear about/ find us
Social media
Google Search
Saw Van Driving
Word of Mouth
Submit
Should be Empty: