Dog Boarding Intake & Authorization Form

Dog Boarding Intake & Authorization Form
Owner Information

Tell us about yourself so we can contact you as needed.
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Emergency Contact Name & Relationship*
Emergency Contact Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Pet Information

Details about your dog to ensure their safety and comfort.
Dog's Name*
Breed*
Age (years)*
Weight (lbs)*
Sex*

MaleFemale
Is your dog spayed or neutered?*

YesNo
Vaccination Status*

Up to dateNot up to dateUnknown
Upload Vaccination Records*

Cancelof
Veterinarian Name*
Veterinarian Phone Number*
Please enter a valid phone number.
Temperament & Behavior

Help us understand your dog's personality and needs.
How does your dog interact with other dogs?*

Very friendlyGenerally friendlySelectiveNot friendlyUnknown
How does your dog interact with people?*

Very friendlyGenerally friendlySelectiveNot friendlyUnknown
Does your dog have food aggression?*

YesNoUnknown
Does your dog experience separation anxiety?*

YesNoUnknown
Does your dog have any medical conditions? If yes, please describe.
Is your dog currently taking any medications? Please list medication names and dosages.
Special care instructions (feeding, allergies, routines, etc.)
Boarding Request Details

Let us know the details of your dog's stay.
Check-in Date*

MonthDayYear
Date
Check-out Date*

MonthDayYear
Date
Drop-off Time*

Hour Minutes

AM/PM Option
Pick-up Time*

Hour Minutes

AM/PM Option
Boarding Type*
Additional Services Requested

check in/ Check out bathsNail TrimFull GroomingAnesthesia Free Dental CleaningOther
Payment Authorization

you will be sent a payment link through a secondary payment portal to process payment securely.
Cardholder Name (as it appears on card)*
Billing Zip Code*
Payment Authorization Agreement: By submitting this form, I authorize the boarding facility to store my payment information for future charges related to my dog's stay. I understand that my card will be securely processed and charged on a different platform, and that no sensitive payment information is collected on this form.
Date Signed*

MonthDayYear
Date
By signing this form you confirm, you have read and fully understand our agreements of service Signature *

Powered by Jotform SignClear
Should be Empty:

Dog Boarding Intake & Authorization Form

Owner Information

Pet Information

Temperament & Behavior

Boarding Request Details

Payment Authorization