Untitled Document

Boarding Registration Form
CANINE COMMUNICATIONS DOG PSYCHOLOGY CENTER 2901 Exposition Blvd., Los Angeles, CA 90018 Phone (323) 731-0955 Fax (323) 731-0990 http://www.brandonfouche.com Brandon@brandonfouche.com This boarding registration form is required for all dog(s) staying at the Canine Communications facility. If you have more than one dog, please include information and pictures for all of them. Appointments can be scheduled once we receive the following: Registration form, dog license, sterilization certificate, shot records (including current bordatella no later than 7 days prior to arrival) and agreement form. All dogs staying at our facility must provide their own food. All dogs coming from a shelter must first be quarantined for a minimum of 10 days. All payments are due at the time of service.
Date: Owners Name: Address: Home Phone: Cell Phone: Work Phone: Fax: Email: California Drivers License: Veterinarian Phone: Veterinarian Address: Emergency Contact Name: Emergency Contact Phone: Dog information #1 Dog's Name: Breed: Age: Sex: Weight: Neutured/Spayed: Dog License: Vaccinations DHLPP Date Due: Rabies Date Due: Bordetella Date Due: Flea Product Date Due: Brand of Food: Medical Problems: Medication: Flea Product: Behavior Problems: Jump fences/Escape enclosures? Explain: #2 Dog's Name: Breed: Age: Sex: Weight: Neutured/Spayed: Dog License: Vaccinations DHLPP Date Due: Rabies Date Due: Bordetella Date Due: Flea Product Date Due: Brand of Food: Medical Problems: Medication: Flea Product: Behavior Problems: Jump fences/Escape enclosures? Explain: #3 Dog's Names: Breed: Age: Sex: Weight: Neutured/Spayed: Dog License: Vaccinations DHLPP Date Due: Rabies Date Due: Bordetella Date Due: Flea Product Date Due: Brand of Food: Medical Problems: Medication: Flea Product: Behavior Problems: Jump fences/Escape enclosures? Explain: