845.279.6578  |  BOOK AN APPOINTMENT  |  

Roosevelt Mansion

Dog Boarding Application Form

Please complete the Roosevelt Mansion Dog Boarding Application as a first step in bringing your dog to board with us.
Thank you for your interest in the Roosevelt Mansion.
We look forward to meeting you and your dog!

OWNER / GUARDIAN INFORMATION

Please indicate whom we would contact in case of an emergency, if we could not reach you.

PET'S VETERINARIAN INFORMATION

Please fill in full business name of veterinary clinic.
Please use the most direct phone contact to your veterinarian.

PET GUEST INFORMATION

MEDICAL HISTORY

NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION ADMINISTRATION FORM FOR EACH PET.

VACCINATIONS

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.

VERIFICATION

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 use your cursor to sign here.
Please type name if you cannot sign.