Client Name:  Last  ________________________First _______________________MI _____

Address:  _______________________________    Phone:  __________________________

                 _______________________________    Work #:  __________________________

                 _______________________________    Cell #:  ___________________________

E-Mail Address:  ___________________________________    DL #:  __________________

Pet Name                         Breed/Color                 Markings                         

_________________    _______________    ___________________   Age _____ M/F    N/S

_________________    _______________    ___________________   Age _____ M/F    N/S

_________________    _______________    ___________________   Age _____ M/F    N/S

_________________    _______________    ___________________   Age _____ M/F    N/S

Veterinarian/Clinic___________________________________________________________

                                Phone _________________________

                                Address ____________________________________________________

Emergency Contacts __________________________________ Phone _________________

Emergency Contacts __________________________________ Phone _________________

In addition to owner, who may we release your pet to? Specify who and relationship.
_________________________________________________________________________

Does your pet have health concerns?  Explain ______________________________________
_________________________________________________________________________

Vaccinations

                       Rabies: ___________________________________    _____ 1yr    _____ 2yr
                       Bordetella: ____________________________________________________
                       DHLPP: ______________________________________________________
                       Corona (puppies only): ___________________________________________

Note: Barking Lot, Inc. requires proof of current vaccinations. Bordetella, every 6 months, DHLPP every 12 months and Rabies per state law. All vaccinations must be given at least 3 weeks prior to your pet's stay with us. In addition, we require a 10-day waiting period before entrance to our facility if your pet has visited a dog park, been exposed to infections disease, boarded at a veterinary clinic or is being treated for an infectious disease.

Flea/Tick Prevention ____ Y ____ N                            Type _____________ Last Given ________________
Note: Barking Lot, Inc. requires the use of flea/tick prevention. If a pet arrives with parasites, we require a flea/tick bath at owner's expense and owner will be asked to provide us with a topical treatment such as Frontline Plus in which to give the pet 2 days after the flea/tick bath. If pet has never used a topical flea/tick preventative we will request owner to contact his/her veterinarian for approval.

Heartworm Prevention ____ Y ____ N    Type ____________ Last Given ________________

Boarding Dates Desired: _____________________________________________________

Accommodation: ____ Private Suite    ____ Modern Suite    ____ Traditional Suite

Day Camp: ____ Y ____ N    How many days? ____    Which days? ____________________

Leash Walk: ____ Y ____ N    How many days? ____    Which days? ___________________

Special Meal Service:               ____ Y ____ N                   ____1x ____ 2x ____ 3x per day

Feeding Instructions: ________________________________________________________
                                                                                                                              What Do You Feed?

Medication: ____ Y ____ N   Details on Rx and how to give:___________________________
________________________________________________________________________

GROOM: ____ Y ____ N    Date Requested: ______________________________________

Specify Service: __________________________    Detail style/length etc. ______________
________________________________________________________________________

General Questions About Your Pet

Crate Trained     ____ Y ____ N     Obedience Trained  ____ Y ____ N    Afraid/Thunder    ____ Y ____ N
Snipes Humans ____ Y ____ N     Walks on Leash      ____ Y ____ N    Dog Aggressive  ____ Y ____ N
Likes to Chew    ____ Y ____ N     Likes to Dig            ____ Y ____ N    Climbs              ____ Y ____ N
Allergies            ____ Y ____ N     Any Phobias           ____ Y ____ N    Marks               ____ Y ____ N

Explain any YES answers in detail and anything else you would like for us to know including favorite toy, treat, food.
_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Please provide your pet with a quick release collar appropriately fitted for his/her stay. In case of a building evacuation, we will escort all pets to a designated tie out area and proceed with safety measures.

_______________________________________________________________________________________________