OWNER / GUARDIAN INFORMATION
Please indicate whom we would contact in case of an emergency, if we could not reach you.
PET'S VETERINARIAN INFORMATION
PET GUEST INFORMATION
NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION ADMINISTRATION FORM FOR EACH PET.
Please list the current expiration dates for the following vaccinations: (front desk may complete once they’ve received proof of current vaccinations). Bordatella vaccination must be administered at least 7 days prior to any services at The Roosevelt Mansion; 3 days for nasal vaccination.
I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner or representative of the dog subject to this application that my signature is sufficient to enter into this application for and on behalf of any owner or representative.
Please type name if you cannot sign.