Client Information Sheet

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Cell Phone *

Day Phone

Evening Phone

Emergency Back-up Information

Please list someone OTHER THAN YOURSELF or your partner in case you are unreachable in an emergency.

Emergency Contact Name *

Cell Phone

Day Phone

Evening Phone

Emergency Contact 2 (Optional)

Emergency Contact Name

Cell Phone

Day Phone

Evening Phone

Pet Description

Name *

Breed *

Color *

Weight *

Birthdate *

Spay/Neuter *

Personality (likes and dislikes)

Briefly tell us anything that might assist us with managing your pet and making sure his/her stay is enjoyable.

Medical Issues *

None
Other (Details Required Below)

Veterinary Practice Name *

Veterinary Practice Phone *

Special Dietary Needs *

None
I will provide food
Other (Add details below)

Canine Playtime Program

Extra Playtime Options:
30 minutes once daily = $7.00
30 minutes twice daily = $12.00
20 minutes one-on-one=$12.00

Are You Interested in the Playtime Program? *

PRESTON COUNTRY CLUB FOR PETS

Where happy pets stay

PRESTON COUNTRY CLUB FOR PETS

Where happy pets stay

Client Information Sheet

Emergency Back-up Information

Emergency Contact 2 (Optional)

Pet Description

Canine Playtime Program

Holiday Hours – Click for Details