Pet’s Name: (Nicknames) _________________________________________________

Owner’s Name: __________________________________________________________

Address: __________________________________ E-mail Address: _______________

Home Phone: ______________________________ Cell Phone: ___________________

Emergency Contact & Authorized Guardian

Name: _________________________________________________________________

Home Phone: ______________________________ Cell Phone: ___________________

Veterinarian Information

Vet/ Clinic: ________________________________

Address: __________________________________Office Phone:__________________

at the lodge we believe that your pet's welfare is our priority. Therefore, we will provide

reasonable care at all times. In case of  emergency or illness, we will promptly bring your

pet to a veterinarian. You will be responsible for all charges for your pet’s well being.

All dogs are boarded at the owner's risk.

Please note: All pet’s vaccination records need to be verified before checkin.

Payment due upon pick-up.  Cash only at this time.

Please sign below for authorization.

Signature: _____________________________________ Date: ____________________

If you would like your dog to have a playmate during his/ her stay please sign below. We only

mix dogs in a very small group of compatible dogs during supervised playtimes.

Signature:______________________________________ Date:____________________

MY DOG

Name:____________________________________ Breed:________________________

Age:__________Sex:______Spayed/neutered:_______ ___Weight (approx):___________

Color and markings:________________________ Eye color:_______________________

Dog collar (color):_______________________ ID tag/or microchip#_________________

Health Concerns/Medications:______________________________________________

Behavior Notes:__________________________________________________________

Habits:___________________________________ Aggression:_____________________

Afraid of thunder: yes/no What direction would you give us for that event?

Food Brand (how much & how often):_AM               PM              Special notes_________

  _____________________________________________________________________

Way or place to be petted: _________________________________________________

Treats allowed: yes/no

Tartar Busters (all natural cow kneebones): yes/no $1.50 @

Kongs: yes/no peanut butter/cheese whiz (complimentary)

Cedar Run Pet Lodge (Please print and complete. Some computers require copy/paste to word)