PUPPY PALS' Enrollment Form

Complete this form and fax it to (661) 261-3398

CLIENT PROFILE

Owner's Information
First Name * Last Name *
Home Phone * Cell Phone
Work Phone * Fax Number
Email Address

Second Owner's Information (not required)
First Name Last Name
Home Phone Cell Phone
Work Phone Fax Number
Email Address

Home Address *
 
City *
State * Postal Code *

Home Pickup Instructions Home Drop-Off Instructions

Emergency Contact Relation Reach Number(s)
At least one emergency contact is required even if it's just your own cell phone.

Vet * Clinic *
Address Phone *

How Did You Hear of PUPPY PALS?

Days/Dates Desired
  From (Home Pick-Up) To (Home Drop-Off)
1.
2.


DOG PROFILE

Dog's Information
Name * Breed/Desc. *
Weight *  lbs. Sex *
Birthdate * Spayed/Neutered *
Health Issues
(include allergies)
Food
(Yours you'll send or PUPPY PALS')
Regular Medications/Reasons
Ever Aggressive? *
Excessive Barker? *
Last rabies date * Last dhlpp date *
Last bordatella date * Last fecal/neg. result *

Second Dog's Information (not required)
Name Breed/Desc.
Weight  lbs. Sex
Birthdate Spayed/Neutered
Health Issues
(include allergies)
Food
(Yours you'll send or PUPPY PALS')
Regular Medications/Reasons
Ever Aggressive?
Excessive Barker?
Last rabies date Last dhlpp date
Last bordatella date Last fecal/neg. result

Third Dog's Information (not required)
Name Breed/Desc.
Weight  lbs. Sex
Birthdate Spayed/Neutered
Health Issues
(include allergies)
Food
(Yours you'll send or PUPPY PALS')
Regular Medications/Reasons
Ever Aggressive?
Excessive Barker?
Last rabies date Last dhlpp date
Last bordatella date Last fecal/neg. result


CLIENT AGREEMENT


  • My dog is (dogs are) at least 4.5 months old, over 25 lbs. in weight, friendly and social with other dogs and people, spayed/neutered, and in excellent health. I understand that, with any significant display of aggression or behavior issue as determined by PUPPY PALS, my dog will be separated from the remainder of the group and penned for the duration of the stay.

  • Before each reservation, I will provide PUPPY PALS with vet records validating that my dog is current on rabies dhlpp, and bordatella vaccines and has had a fecal test with a negative result in the past year.

  • My dog will be fed PUPPY PALS premium dog food, or I will send my own food from home (dry food in sealed bags).

  • I'll provide any medications in sealed bags with dosage and storage instructions plus the reason for administering at pick-up.

  • I authorize PUPPY PALS to use its best judgment in treating any illness or injury using a vet of its choice for which I will pay. I understand the inherent risks of outdoors and dog play, and waive any claim against PUPPY PALS' owners, employees, agents and clients.

  • I authorize photography of my dog for PUPPY PALS' sole use in its promotion.

  • If my dog chews up a bed, I agree to pay PUPPY PALS $150 and know that my dog will thereafter be crated without a bed.

  • I will pay PUPPY PALS' fees IN ADVANCE by VISA or MASTERCARD:

    Name on Card *
    Card Type *
    Card Number *
    Expiration Date *  
    Card Verification
    Number *    		   Help finding your Card Verification Number
     
  • I will pay $100 cancellation fee if cancellation is not called in by 4:00 PM the prior business day.

 I understand and agree to the above terms and conditions.
Please enroll my dog(s) in PUPPY PALS.

 
* Required Fields