New Client Form

Drop-off Date
Drop-off Time
Pick-up Date
Pick-up Time
First Name
Last Name
Email
Mailing Address
City, State Zip
Phone Number
EMERGENCY CONTACT

Emergency Contact Name
Emergency Phone


PET INFORMATION

Pet’s Name
Breed(s)
Gender
Weight
Color(s)
Birthdate/Age
Medication
Bite History

VET/VACCINATION INFORMATION

Veterinarian’s Name/Clinic
Vet Phone
Vet Address
Vet City, State Zip
Vaccinations
Please list the expiration dates for vaccinations.

Rabies
DHPP (Dog)/FVRCP (Cat)
Bordatella; aka: Kennel Cough (Dog)
Microchip ID#
Feeding
Please bring food pre-portioned in ziplock baggies with pet’s name.
How does your pet eat?
Last fed?
Has your pet been ill in the past 30 days; displaying any unusual symptoms such as coughing, sneezing or upset stomach?


Are there any restrictions that need to be placed on your dog’s physical activities or movements?
Does your dog eat or chew on his bedding?



We strive to keep your pet healthy and happy while here, however, sometimes, even under the best of situations, animals have unforeseen health/emergency problems. Therefore we need you to read and sign the following statement:  

I understand that if my pet requires immediate or emergency treatment while here, STERLING ACRES KENNEL LLC staff will make an attempt to contact me. If the staff is unable to contact me, I consent to any actions necessary in the judgment of a licensed veterinarian for life saving procedures not to exceed $_________________. *If blank ‘unlimited’ is assumed.
Your form has been submitted. Please recognize that your reservation is not completed until you receive confirmation. You may email a copy of vaccinations to sterlingacreskennel@gmail.com, or bring a hard copy with you for verification at check-in.
There has been some error while submitting the form. Please verify all form fields again.