CWT Pre-Registration

Camp Wagon Tails Pre-Registration

Please complete this form in order to expedite drop-off procedure for Camp Wagon Tails boarding and day camping. Full deposit is expected at time of drop-off for new clients. If estimate will be over $250 or pet has not been here in over 2 years, a 50% deposit is required at the time of drop-off.
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Pet Name*

First NameLast Name
Pet Age*
Pet Breed*
Sex of Pet*
Drop-Off Date & Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Pick-Up Date & Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
Emergency Contact *

Name Phone Number
Is emergency contact allowed to make medical decisions regarding patient's health?*

NoYes, but only $250 in treatmentYes, but only $500 in treatmentYes, no limit to treatment amount
I give permission for this person to pick up my pet in the event I'm unable to make the pick-up time myself.
Pick-up Name
CPR Consent
Due to the extensive levels of care many of our boarders need, it is necesssary to know your wishes should life saving procedures need to be administered. Decisions regarding CPR and injectable medications to attempt to regulate heart and breathing are critical, and we must be prepared ahead of time. We do not anticipate any issues during your stay, but as we board many medically complex pets in this facility, we must know how you wish to proceed.

Please indicate below if you consent to CPR in the case of emergency.

Should you have any further questions regarding CPR, the cost and possible expectations, please let us know at check-in and we will have an assistant go over the details at that time.
I acknowledge my choice regarding resuscitation for my pet as noted below.*

Please proceed with basic cardiopulmonary resuscitation (CPR). I accept responsibility for all costs incurred.Please DO NOT proceed with basic cardiopulmonary resuscitation (CPR).
Baths & Other Services
Would you like for your pet to have a bath or any other services before they go home?*

BathConditioner and FacialNail TrimNail DremmelAnal Gland ExpressionNo other services needed
Diet
Will you bring your pet's food OR use food provided by Camp Wagon Tails?*
If your pet is not eating well, is it okay to add some wet food?*
How many cups do you feed at each feeding? *
How many times per day do you offer food?*
If your pet is only fed once per day, is it in the morning or evening?
Are we allowed to feed any treats while they are here?*
Does your pet have any food allergies?*
If your pet does have food allergies, list them below.
Health Check
Does your pet need an exam for a medical condition while they are in our care?*
Please list concerns or areas to be examined while in our care.
Please list any ongoing medical conditions your pet may have.
Is your pet a senior or geriatric? (Average age of 10+ years old)*
We want to make sure your pet is comfortable and well taken care of while boarding with us. Our Camp Wagon Tails boarding does not offer the same one-on-one care and monitoring that our hospital boarding can offer to senior pets. If you are interested in having your pet boarded on our hospital side, please check below.

My pet has further medical needs that would benefit from one-on-one handling with technicians and veterinary assistants. I would like to board my pet at the hospital.My pet does not need additional care and I would like them to be boarded at Camp Wagon Tails.I would like more information on both hospital and Camp Wagon Tails boarding before making a decision.
Medical Questions
Has your pet experienced any coughing, sneezing, gagging, vomiting, diarrhea or seizures in the last two weeks?*
If yes, please note which symptoms your pet has been experiencing.
Has your pet had any recent changes in eating, drinking, or bathroom habits?*
If yes, please note which symptoms your pet has been experiencing.
Medications
We require all original packaging for both over the counter and prescription medications.

*Please do not pre-pack them in your pet's food or pill boxes.*
Is your pet currently taking any medications?*
Please list all medications and dosage your pet is currently taking.
List dosage, frequency and start date.
Blankets/Toys
Is your pet allowed to have blankets/toys in cage/run with them? *
Prevention
We do require documented proof that your pet is on approved monthly flea prevention. This can be medical records from another clinic or a receipt from the store where it was purchased. Otherwise a Capstar will be given when arriving and also before they leave.
Please list brand and dose of current flea prevention.*
Please list brand and dose.
When was last dose of flea prevention given?

MonthDayYear
Date
Required Vaccinations

Please read carefully and fill out what vaccines are needed.
Canine Vaccines Required

Rabies Vaccine

Bordetella (Kennel Cough) (required every six months)

Distemper/Hepatitis/Parvovirus/Parainfluenza

Feline Vaccinations and Test

Rabies Vaccine

Distemper/Rhinotracheitis/Calicivirus/Chlamydiosis

Feline Leukemia/Feline Immunodeficiency Test (Required yearly)
Vaccination Permission/Consent*

I have read and understand that these are the vaccines required to stay with Lazy 5 Vets/Camp Wagon Tails. By checking this box, I am verifying that my pet has all of these required vaccines.My pet has medical conditions and I need to discuss vaccines further.My pet needs additional vaccines...
My pet needs to have the following vaccines updated...

Canine/Feline - Rabies VaccineCanine - Bordetella/Kennel Cough (required every six months)Canine - Distemper/Hepatitis/Parvovirus/ParainfluenzaCanine - CIV Vaccine - Canine Influenza Vaccine (H3N8 + H3N2)Feline - Distemper/Rhinotracheitis/Calicivirus/ChlamydiosisFeline - Leukemia/Feline Immunodeficiency Test (Required yearly)
Acknowledgement
I submit that all the information provided above is true to the best of my knowledge.

I understand that Lazy 5 Ranch Veterinary Hospital is not staffed 24 hours and patients that stay boarding are confined comfortably in cages/runs. They are monitored during our business daytime hours and weekend hours. For evening and weekend 24 hour hospital care, Pet Emergency and Trauma Services does offer this service after-hours.

New Clients - required to leave full deposit at the time of drop-off.

Established Clients - If your estimated bill is going to be over $250 or you have not been to Lazy 5 Vets in the last 2 years or more, we do require a 50% deposit at the time of drop off.
Signature*

Clear
Email*
example@example.com
Email2
example@example.com
Should be Empty:

Camp Wagon Tails Pre-Registration

CPR Consent

Baths & Other Services

Diet

Health Check

Medical Questions

Medications

Blankets/Toys

Prevention

Required Vaccinations

Acknowledgement