Name of owner __________________________________________

Address of owner ________________________________________

Please list all contact numbers here with preferred contact no. listed firstly _______________________________________________________

Date of commencement of boarding : _________________________

Collection date : __________________________________________

Name of dog(s) : __________________________________________

Age of above dog(s) : ______________________________________

What food are your dog(s) fed and what times during the day ? _______________________________________________________

Are your dog(s) allowed treats of any kind ? _______________________________________________________

Is your dog(s) food or toy possessive ? _______________________________________________________

Is your dog(s) happy for a walk and if so, is your dog(s) able to be off lead on walks ? _______________________________________________________

Has your dog(s) a habit of running off ? We often see herds of wandering deer so please be honest ! _______________________________________________________

What length of time can your dog(s) walk happily for ? _______________________________________________________

Is your dog(s) happy meeting strangers and dogs on walks ? ________________________________________________________

Can your dog(s) be left for short periods of time ? ________________________________________________________

Where do your dog(s) sleep at night ? ________________________________________________________

Please list here any "issues" your dog(s) has that we should know about, this could be

anything from barking, separation anxiety, toy guarding, fear of strangers or chewing his feet. ________________________________________________________

________________________________________________________

Is your dog Microchipped/Tattooed ?

If so, please list the details here

________________________________________________________

Are there any medical conditions underlying for your dog(s) ?

If so please ensure these are written here, and any medication required to be

given during your dog(s) stay is fully explained : _______________________________________________________

_______________________________________________________

_______________________________________________________

Please list your dog(s) insurance details and if possible policy No. _______________________________________________________

_______________________________________________________

Please list your vets details : Veterinarian:

____________________________________________

Vets Phone: _____________________________________________

Address: ________________________________________________

Shelley Haggerwood will always make every effort to contact me the owner of my abovenamed dog(s) if they become sick and it is deemed they require emergency veterinary care in my absence.

If no contact is able to be made and treatment is urgent, by signing below I allow Shelley Haggerwood the authority to take my dog to a registered vet if she feels it is a life threatening ailment and veterinary treatment is crucial for the welfare of the dog.

TO THE VETERINARY SURGERY:

During my absence, Shelley Haggerwood will be caring for my dog(s) and has my permission to transport them to your surgery for treatment. I authorise you to treat my dog(s) and will be fully responsible for payment upon my return. I hereby give Shelley Haggerwood permission to transport my dog(s) to a veterinary surgeon.

I understand that Shelley Haggerwood assumes no responsibility for the loss of my dog(s) and is released from all liability related to transportation, treatment and expense.

Signed by owner of the above dog(s)

____________________________

Print Name ___________________________

Dated ________/__________________2010