Pine Creek Pet Resort - Pet Information Form

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Owner's Name: _______________________________________ Home Phone: _____________________

Street Address: _______________________________________ Cell Phone: _______________________

City: ____________________________________________ State: ____________ Zip: ________________

Email: ____________________________ Website: ____________________________________________

Emergency Contact: ___________________________________ Number: _________________________

Requested Dates of Stay: _________________________________________________________________

Estimated Time of Arrival: ____________________ Expected Pick-up Time: _______________________

If you have multiple pets, would you like them in the same room? (Pets must cohabitate peacefully) YES NO

If NO, Please Explain: ____________________________________________________________________

Pet Profile

1. Pets Name: _________________________________________ Age/DOB: ________________________

Weight: __________ Color: _________________________ Gender: Male Female Neutered Spayed

Name of Current Pet Food: ________________________________________________________________

Does your pet chew bedding? YES NO Does your pet have allergies? YES NO

Describe Allergies: _______________________________________________________________________

Is your pet currently taking medication? YES NO

1. Medication: ________________________________ Morning Afternoon Evening Quantity ____________

2. Medication: ________________________________ Morning Afternoon Evening Quantity ____________

For unspayed females only. Date of last heat: ________________________________________
Females in heat are not accepted for boarding as it severely disrupts our daily schedule, females that come into heat while boarding will be subject to a $30 daily surcharge.

2. Pets Name: ____________________________________________ Age/DOB: ______________________

Weight: __________ Color: __________________________ Gender: Male Female Neutered Spayed

Name of Current Pet Food: _________________________________________________________________

Does your pet chew bedding? YES NO Does your pet have allergies? YES NO

Describe Allergies: ________________________________________________________________________

Is your pet currently taking medication? YES NO

1. Medication: _______________________________ Morning Afternoon Evening Quantity _____________

2. Medication: _______________________________ Morning Afternoon Evening Quantity _____________

A wide variety of Resort Amenities are available to compliment your pet's stay. Our staff will help you select a custom vacation package that suits your pet's needs and personality.

Vaccination Records

In the interest of keeping all of our boarding pets safe we require that all pets be current on required vaccinations. Contact us for a copy of our vaccination requirements to take to your veterinarian.

Ideally, all vaccinations should be administered 2 to 3 weeks prior to lodging. Special arrangements are required for pets who have been vaccinated within 7 days prior to checking in. Accommodations are limited, contact 570-864-3189. Titer tests or proof of vaccinations must be presented for admission.

Veterinarian: __________________________________________ Phone: __________________________

How did you hear about us? Please select all that apply.

Website Yellow Book EZ to Read Newspaper Flyer Email Billboard Special Event Other

Other: _______________________________________________________________________________

Is this a first time boarding experience for your pet? YES NO

If NO, what was the date of the last boarding? ______________________________________________

Describe your pet's experience: __________________________________________________________

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About Your Pet's Personality

How long have you had your pet?

Pet 1 (Name & Time): ___________________________________________________________________

Pet 2 (Name & Time): ___________________________________________________________________

How did you acquire your pet?

Pet 1 (Name & Time): ___________________________________________________________________

Pet 2 (Name & Time): ___________________________________________________________________

How would you describe your pets temperament?

Pet 1: _______________________________ Friendly Shy/Timid Restrained Aggressive Aggressive

If you select Shy/Timid, Restrained Aggressive or Aggressive, tell us why: ____________________________

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Pet 2: ________________________________ Friendly Shy/Timid Restrained Aggressive Aggressive

If you select Shy/Timid, Restrained Aggressive or Aggressive, tell us why: ____________________________

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Has your dog(s) ever bitten a person? Describe the situation.

Pet 1 (Name & Info): ___________________________________________________________________