COUNTRY INN KENNEL
CLIENT INFORMATION RECORD

DATE________________________
OWNER_______________________________________________________________________________
ADDRESS_____________________________________________________________________________
HOME PHONE_________________________CELL PHONE____________________________________
E-MAIL_______________________________________________________________________________
EMERGENCY CONTACT NAME & PHONE________________________________________________
OTHER PERSON(S) AUTHORIZED TO PICK UP PET(S)_____________________________________

PET INFORMATION:

PETS NAME________________________________BREED____________________________________
BIRTH DATE_______________________________NEUTERED/SPAYED________________________
COLOR____________________________________WEIGHT___________________________________
VET_________________________________________PHONE #_________________________________
VET MAY FAX IMMUNIZATION RECORDS TO US AT 920-749-4801 OR BRING THE FOLLOWING RECORDS WITH YOU:
RABIES EXP. DATE______________________CANINE BORDETELLA***______________________
CANINE DISTEMPER___________________________________________________________________
LAST FLEA/TICK PREVENTATIVE: ______________________________________________________
TYPE & DATE _________________________________________________________________________

***PLEASE NOTE:  WE REQUIRE A BORDETELLA VACCINATION ANNUALLY AT LEAST 14 DAYS PRIOR TO BOARDING WITH US TO INCREASE EFFECTIVENESS BUT  BORDETELLA IS NOT 100% EFFECTIVE; COUNTRY INN KENNEL MAKES NO GUARANTEES IN REGARDS TO BORDETELLA!

FIRST TIME BOARDER?_________________HEAT/COLD SENSITIVE_________________________
ALLERGIES____________________________CHEWER______________________________________
AGGRESSIVE WITH PEOPLE______________________EXPLAIN_____________________________
AGGRESSIVE WITH DOGS________________________EXPLAIN_____________________________
PREVIOUSLY ABUSED___________________________HIP DYSPLASIA______ARTHRITIS_______
MEDICAL CONDITIONS________________________________________________________________
RECENT MAJOR SURGERY/ILLNESS_________________________TYPE & DATES_____________
OTHER SPECIAL NEEDS/COMMENTS___________________________________________________
HAS YOUR DOG EVER BITTEN ANYONE?___________EXPLAIN____________________________

MEDICATIONS____________________________________AMT. & FREQUENCY_________________

FEEDING INSTRUCTIONS:
YOUR OWN FOOD OR OURS?___________________________________________________________    
AMOUNT AND HOW OFTEN?___________________________________________________________
COMMENTS:__________________________________________________________________________

WE APPRECIATE A MEET AND GREET PRIOR TO BOARDING TO SEE HOW YOU PET WILL ADJUST TO BOARDING.  ANY DOG THAT SHOWS PROBLEMS ADJUSTING WILL BE SEGREGATED AND NOT ALLOWED SOCIAL TIME WITH THE OTHER DOGS.  TOURS ARE WELCOME!