Cricket Hollow Farm Kennels

Boarding Check in Form

This is NOT a registration. You MUST register by telephone.

TAB between fields. *indicates required field.

Submit on-line or print and bring in during Check-in.

Your Information

*Your Name:

Home Address
*Street:

*City: *State: *Zip:

*Day Phone: *Evening Phone:

E-mail:

Your Veterinarian

*Vet Name:

Practice Name:

*Office Phone: Office Fax:

*After Hours Phone:

*Vet 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 Number 1:
*Name:

*Day Phone: *Evening Phone:

Contact Number 2:
*Name:

*Day Phone: *Evening Phone:

Contact Number 3:
*Name:

*Day Phone: *Evening Phone:

Contact Number 4:
*Name:

*Day Phone: *Evening Phone:

PET INFORMATION

*Pet's Name:

*Breed: *Color(s):

*Approx date of Birth: *Sex: Male Female

*Spayed/neutered? Yes No

Medical Conditions & Health Record:

Conditions or Health Concerns:

Prescriptions:
Schedule:

Allergies:

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

If your pet does not reside in Illinois, we will require a health certificate from your veterinarian upon check-in.

Please bring your written proof of vaccinations at check in time.

*PERSONALITY

Please answer the following questions about your pet. Honest answers will help us to understand and care for your pet, as well as protect our family.

Please describe your pet using the following table, where 1 is NOT AT ALL, and 9 is QUITE A LOT. Check the box that best describes your answer.

Is your pet especially afraid of anything (such as thunderstorms)? Yes No N/A
If so, what?

Is there any place on your pet's body that he/she does NOT like to be touched or petted? Yes No N/A
If so, where?

Is there any place on your pet's body that he/she especially LOVES to be touched or petted? (other than ALL OVER)! Yes No N/A
If so, where?

Does your pet have any peculiar habits? Yes No N/A
If so, what?

Has your dog every 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:

Is there anything else you would like us to know?

If you are boarding more than one dog, please submit, hit the back button and fill in again with second and subsequent dog info. When you come to check in, please come prepared with your itinerary and contact information, as well as your vaccination records.