Camp Wignall Registration Form

Camp Wignall Registration Form

1837 Bridge Street ■ Dracut MA 01826

Tel:978-454-8272 Fax: 978-458-4646

Parent Information

Date:*

Name:*

FirstLast

Email*

Home Phone:*

Cell Phone:

Account #

While my pet is boarding/in daycare, I can be reached at:*

In case of emergency, these people are authorized to make decisions on my behalf:

Name

FirstLast

Phone

Name

FirstLast

Phone

Name

FirstLast

Phone

*Please advise your emergency contacts that they are responsible for making medical decisions for your pet if we are unable to reach you.

Camper Information: Boarding and Daycare

Camper Name:*

Boarding Dates:*

MM

DD

YYYY

to

*

MM

DD

YYYY

Does your pet get along with others?*

Yes
No

Do you want your dog to play in a Play Group?*

Yes
No

Do you want your dog to go out Only Alone? *

Yes
No

Pick Up Time*:*

: HH

MM

*Note Pick up AFTER 11AM will be charged full day

I understand there are certain risks involved with playing in groups and accept financial responsibility for them and my dog; and I understand that WAH Kennel Staff will make every effort to minimize those risks.

(initial) *

FEEDING: When do you feed your pet?*

AM
PM
Both

What type of food do you feed your pet?*

Wet
Dry

What quantity of food does your pet eat each feeding?

Cups
Cans

Number *

Does your pet have any dietary restrictions?

Yes
No

If YES, please list what:

BATH: (includes 2 brushouts, nail trim, ear cleaning, bath, conditioning before going home) *

Yes
No

HAIR CUT:*

Yes
No

Trim Instructions: Length of hair desired for face:

ears:

legs:

feet:

chest:

back:

other:

MEDICAL: Is your camper Spayed or Neutered? *

Yes
No

Is your camper on any medication?*

Yes
No

All medications must be in original packaging. Medication information must be provided upon check in.

VACCINATIONS/PHYSICAL EXAMS: Unvaccinated or overdue campers will be given a physical exam and the appropriate vaccinations and/or tests at pet owner's expense. Vaccine records from other veterinarians must be received prior to the camp Check In Date. The following vaccinations/test are required for Camp Wignall pets: (1) Rabies, (2) Distemper, (3) Bordetella (dogs only) and (4) Parasite Test. Distempter: DOGS/DHLPP: Distemper/Hepatitis/ Leptospirosis/Parainfluenza/Parvovirus, ONE YEAR (unless Continuum or Duraimmune). NOTE: Leptospirosis MUST be boostered EVERY YEAR; CATS/FVRCP: ONE YEAR (unless Continuum or Duraimmune); FERRETS/ D: ONE YEAR. Infectious Bronchitis: DOGS/Bordetella, ONE YEAR; Parasite Test : DOGS/CATS (fecal test done within the last 12 months, negative results). Physical Exam Fee :$62 ■ Vaccination Fee: $29/each (LYME/FeLV Vaccinations: $32/each) ■ Parasite Exam Fee: $39 (Positive Fecal Exam performed during boarding/daycare stay requires immediate treatment during stay at owner expense) ■ Medication Administration Fee: $10.50/day

Camp Wignall is part of Wignall Animal Hospital. As an animal hospital, we expect to provide the best possible complete care to all our boarding pets. This includes monitoring every pet’s overall health during his/her stay and providing proper diet, exercise, recreation and medical care, if needed. Wignall Animal Hospital will treat any camper in a life threatening emergency or serious illness lasting more than 24 hours or if contagious to other pets. Our staff will contact the pet’s owner/emergency contact, whenever possible, before treatment is started. All treatment costs are the responsibility of the pet’s owner, including the initial physical examination ($62) when one is needed.

By signing I agree to all of the above.*

Date*

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