Daycare Application

Daycare Application
New or Returning Guest*
First Name:*
Last Name*
Email Address*
Cell Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How did you hear about us?
Name of Your Vet Office:
Spouse's Name
Spouses's Cell Number
Spouses's Email Address
Home Number
If you use one
Emergency Contact (someone who doesn't live in same house)*
Emergency Contact's Number*

Area CodePhone Number

Furry Guest's Name
Date of Birth/Approximate Age
Weight
Sex/Been Fixed
Breed
Color
Date Last Flea Med Was Given
Do you have any other guests*

Furry Guest 2
Name Of Your Vet If Diffrent
Date of Birth/Approximate Age
Weight
Sex/Been Fixed
Breed
Color
Name of Flea Medication Used
Date Last Flea Med Was Given
Do you have any other guests*

Furry Guest 3
Name Of Your Vet if Diffrent
Date of Birth/Approximate Age
Sex/Been Fixed
Weight
Breed
Color
Name of Flea Medication Used
Date Last Flea Med Was Given
Do you have any other guests

Furry Guest 4
Name Of Your Vet if Diffrent
Date of Birth/Approximate Age
Weight
Sex/Been Fixed
Breed
Color
Name of Flea Medication Used
Date Last Flea Med Was Given
Do you have any other guests

Furry Guest 5
Name Of Your Vet if Diffrent
Date of Birth/Approximate Age
Weight
Sex/Been Fixed
Breed
Color
Name of Flea Medication Used
Date Last Flea Med Was Given

Check In Information
PLEASE READ:

Please refer to our days and hours of operation at your desired location (listed below in red) or call for schedule. Also, this is just a requested date it does not mean it is available. Please make sure you have talked to someone and confirmed prior to coming in.
What days a week are you interested in daycare? Mark all that apply.

MondayTuesdayWednesdayThursdayFriday
Daycare: Daycare is at Pentz Street Monday-Friday drop off is 7:30 am to 8:30 am and pick up is 4:30 pm to 5:30 pm. We only do full days in daycare, and these are set times. We also only allow a set number of dogs per day so it must be approved before you come.

Grooming: Groom appointments are offered at the Kennel on Sane Road on Monday and Saturdays & Pentz Street on Tuesday, Wednesday, Thursday, and Friday. These are appointment only.
Do you Want a Bath or Groom before picking up?

My Products

Daycare Deposit$30.00

This deposit will be applied to your appointment. However, if you do not cancel or reschedule at least 24 hours before you will forfeit the deposit.

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: