REGISTRATION INFORMATION

BICHON FRISE GET AWAY AND RESCUE RANCH, INC.

1979 Carlson Rd., Parker, CO 80138

(720) 851-1671

PETS NAME: _____________________________________ AGE: _____________SEX: _________

BREED: __________________ NEUTERED: __________* Males over 6 months of age must be neutered

Does your pet have any ID on him:_________________(If not, he needs one or we will order one at $8 for you)

OWNERS NAME: ____________________________________________________________________

ADDRESS: __________________________________________________________________________

CITY: ______________________________________________________ZIP:_____________________

PHONE: Home:_________________________________ Work: _______________________________

CELL:______________________________EMAIL: _________________________________________

VETS NAME AND PHONE NO: ________________________________________________________

LOCAL EMERGENCY CONTACT: _____________________________________________________

NUMBER YOU CAN BE REACHED AT WHILE YOU ARE AWAY: _________________________

HOW DID YOU FIND OUT ABOUT US? _________________________________________________

HEALTH HISTORY:

Are DAPP2 and Rabies shots current? _______________

Has your dog had a Bordetella* (kennel cough) vaccine? __________ When: ____________

*Bordetella vaccines are required by law annually for any dog in a boarding facility!

Date of last vet visit and reason:_________________________________________________________

Is this pet on any medication: ________________

If yes, state RX name and reason:_________________________________________________________

List any special dietary needs: ___________________________________________________________

List all conditions this pet has been treated for, dates of treatment and remaining effects: _____________________________________________________________________________________

List any other Special Needs this dog has that we need to be aware of: _________________________
_____________________________________________________________________________________

TEMPERMENT AND BEHAVIOR:

Does your pet get along with other dogs? _____________ Children? ______________

Is there anything your pet is NOT suppose to do/have? (ie: physical limitations, food exclusions*)

*NOTE: we use treats such as yogurt, cottage cheese, chicken, hamburger, rice, carrots, green beans, greenies and pig ears.____________________________________________________________________

DISCLOSURE: I am requesting accommodations for my pet while I am away. I realize this is an open environment, with co-mingling with other dogs, including rescues. Additionally, I realize there are human visitors both adult and children coming and going. I will not hold the Bichon Frise Get Away, its agents, representatives or guests, responsible for any loss, theft, sickness or accident that may occur with my pet while my pet is boarded. I understand that sometimes dogs get dirty, may have diarrhea and/or may throw up. If this is the case with my pet, I realize the “ranch” will bathe my dog, at my expense. I give permission to provide care for my pet, including any medical care that may be necessary. I further agree I will be responsible for boarding fees of $_________ per day and any medication fees of $_______/day vet, grooming bills that may be incurred during this stay. Additionally, I agree to pay for vet bills incurred should my dog cause injury to another dog, or for repair bills should my dog cause damage to beds, doors, etc. while staying at the Bichon Frise Get Away.

SIGNED: _____________________________________________ DATE: _______________________

Intended Dates of Stay: _________________________