All Creatures Country Club Check-in Form

Please fill in this form and either SUBMIT it on-line, or print it and bring it when you check in. E-mailing this form does not mean that a booking has been accepted. You will be contacted by one of our staff for a verification of a reservation.
* shows required fields.

About You

*Your Name:

*Day Phone: *Evening Phone:
(include Area Codes)

E-mail:

Home Address:
*Street Address

*City *State *Zip

Veterinarian Information

*Vet Name:

Practice Name:

*Office Phone: Office Fax:

*After Hours Phone: (include Area Codes)

*Vet Street Address (no PO Boxes)
*Street Address

*City *State *Zip

Emergency Contacts

Please list at least two people who are likely to be able to reach you in the event of an emergency. Furthermore, these people will be authorized to MAKE DECISIONS REGARDING EMERGENCY CARE in the unlikely event you cannot be reached, and/or PICK-UP YOUR PET in the event you are unable to do so. WE CANNOT RELEASE YOUR PET to anyone who is not listed below:

Contact No. 1:

*Name:
*Day Phone:        *Evening Phone:

Contact No. 2:

Name:
Day Phone: Evening Phone:

Pet Number 1

*Pet's Name: *Type:

*Breed: *Color(s):

Approx. date of birth* *Sex: Male Female *Spayed/Neutered? No Yes

MEDICAL CONDITIONS AND HEALTH RECORD:

Medical Conditions or Health Concerns:

Prescriptions:
Schedule:

Allergies:

Digestive or elimination habits or problems we should be aware of:

We will require a health certificate from your veterinarian upon check-in.

* Immunizations
We require WRITTEN PROOF of the following immunizations from your veterinarian upon check-in.

	Date Given
DOGS AND CATS
RABIES
DISTEMPER


DOGS ONLY
BORDATELLA
HEPATITIS
PARAINFLUENZA
PARVOVIRUS
LEPTOSPIROSIS
CATS ONLY
FeLV (Feline Leukemis Virus)
FVRCP (Feline Viral Rhinotracheitis, Calicivirus, Panleukopnia)

Please fill in the following section for DOGS only:

Has your dog ever bitten someone? Yes No N/A

If yes, please explain the circumstances

Does your dog know any basic commands or tricks? Yes No N/A

If yes, please list

Please fill in the following section for CATS only:

Does your cat bite? Yes No N/A

If yes, please explain the circumstances

Is your cat declawed? Yes No N/A If so, how many paws?

Pet Number 2

*Pet's Name: *Type:

*Breed: *Color(s):

Approx. date of birth* *Sex: Male Female *Spayed/Neutered? No Yes

MEDICAL CONDITIONS AND HEALTH RECORD:

Medical Conditions or Health Concerns:

Prescriptions:
Schedule:

Allergies:

Digestive or elimination habits or problems we should be aware of:

We will require a health certificate from your veterinarian upon check-in.

* Immunizations
We require WRITTEN PROOF of the following immunizations from your veterinarian upon check-in.

	Date Given
DOGS AND CATS
RABIES
DISTEMPER


DOGS ONLY
BORDATELLA
HEPATITIS
PARAINFLUENZA
PARVOVIRUS
LEPTOSPIROSIS
CATS ONLY
FeLV (Feline Leukemis Virus)
FVRCP (Feline Viral Rhinotracheitis, Calicivirus, Panleukopnia)

Please fill in the following section for DOGS only:

Has your dog ever bitten someone? Yes No N/A

If yes, please explain the circumstances

Does your dog know any basic commands or tricks? Yes No N/A

If yes, please list

Please fill in the following section for CATS only:

Does your cat bite? Yes No N/A

If yes, please explain the circumstances

Is your cat declawed? Yes No N/A If so, how many paws?

Is there anything else you would like us to know:

When you come to check in, please come prepared with your itinerary and contact information, in the unlikely event that it should become necessary to reach you.