Return Client Registration Form
Customer Details:
First and last name
*
First name
Last name
Phone Number
*
Format: (000) 000-0000.
Dog/Dogs Name
*
Does your dog shred bedding ?
*
Please Select
Yes
No
May
Drop off date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Pick up Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Pick up time
*
Sunday thru Friday 9-12 NOON OR 6-7:30PM Saturday 9-12noon only ( Closed Saturday PMs for pick ups/Drop offs )
AM
PM
AM/PM Option
Has your pet shown any signs of illness such as: Cough, Sneeze,Diarrhea, Vomit, or Running Nose in the last 30 Days?
*
YES
NO
Pet Health
My dog climbs fencing
*
Yes
No
Any suggestions if any for further improvement of our service or business?:
Would you like a groom for your 25lb or under pet?
Full Groom $65+
Nails only $15
Wash and nails only $45+
How do you feel we have done in in the past ?
1
2
3
4
5
Submit
For boarding dogs and owners: By signing this contract I am giving my consent for Lupine Kennels and it's owner to take my dog to the vet if deemed necessary by any of aforementioned parties and that I , the owner of the pet(s), agree to pay for any and all such bills. Should my dog bite or cause injury to another dog or person I agree to pay for any and all such bills. Should my dog bite or cause injury to another dog or person I agree to pay for any and all medical or vet expenses. I also agree to pay all costs for damage done to the kenneling facility by my dog. I understand that I am boarding my pet at my own risk and I do not hold Lupine Kennels liable for any illness, injury or death. I the said owner of the pet agree, that the information provided to Lupine Kennels about my pet to the best of my knowledge to be true
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Should be Empty: