Enzo's Medical Release & General Info

Medical Release & General Info Form

Services you are signing up for:

Training Day-Camp Boarding

Full Name *

First Name Last Name

Partners Name

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

E-mail *

Secondary E-mail

Primary Phone Number *

Area Code Phone Number

Secondary Phone Number

Area Code Phone Number

Additional People who can pick up, deliver or receive information regarding your pup.

Emergency Contact (Other than yourself)

Full Name *

First Name Last Name

Phone Number *

Area Code Phone Number

Pet Information

Pets Name *

First Name Last Name

Breed/Description *

Male/Female *

Spay/Neutered

Yes NO Guardian Pup Breeder

Weight

Birthdate or Age

Microchip Number

License Number

Vetranarian Information

Vet Full Name *

First Name Last Name

Clinic Name

Phone Number *

Area Code Phone Number

E-mail

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Vaccine History (Date of last vaccinations and health check)

DHPP *

Bordetella Due every Year *

Rabies

Health-Check Due Annually *

Clean Fecal test Due within 2 weeks of initial visit *

Flea Treatment Recommended *

Flea Brand

Allergies (Please list)

Health History

Medical History (Illness, injury, surgery, allergies, skin problems, and any other problems that may limit your pup).

On going Medications

I understand that I WILL NOT bring my dog to the dog park, another Day camp or Boarding Facility within 16 days of my scheduled training at Enzo's Dog Training (Minimizes dog sickness) *

Yes, I understand and will follow this strict rule!

Medical Illness or Problem Policy

If while under our care your dog becomes sick/ill, or hurt, we will make every attempt to call you on any phone numbers you provide, including your emergency contact. However, if we are not able to reach you please indicate below what you would like us to do:

Your Instructions: *

Please check per your instructions *

Perform whatever treatment the emergency vet deems necessary at the owners expense. Do NOT administer any medical treatment until authorization from owner or emergency contact is given, either verbally or in writing or text. Please contact our vet first, they are authorized to make decisions as to our pets health.

Authorized Vet

First Name Last Name

Authorized Vet Clinic *

Vet Phone Number *

Area Code Phone Number

Mark to Agree *

I verify my dog is up to date on all required vaccines, including rabies, and that my dog is healthy. I also verify my dog is not sick or does not have any known diseases. I verify my dog is not harmful to other dogs or people. in the event of an emergency and I can not be reached by phone, I allow all staff at Enzo's Acres to transport my dog to a nearby vet clinic that can treat my dog. I agree to pay all expenses for any veterinary services or on-site services that result form occurrence. I have read and fully understand these Rules and Policies and agree to abide by them. Certify I have read the Agreement and Release and I accept the terms and conditions and statements of this agreement. *PLEASE NOTE* Enzos Acres cannot take dogs with grooming needs, past or present injuries, sick or that require special medical or dietary needs. This can interfere with the training & boarding process and requires more time and attention from our staff. If your dog becomes sick after you have booked for our services, please call us to reschedule those services for a time when your dog is healthy. Dawn - Enzo's Acres Inc.

Click to edit *

Month Day Year

Full Name *

First Name Last Name

Partners Full Name

First Name Last Name

How Did You Find Us...Facebook, Google, if referral.. Who ?Referral ?

Please check all boxes that you understand our health regulations. *

I understand that my dog is going to a boarding facility where there are other dogs. I understand my dog can get sick even though he/she is fully vaccinated. I understand Enzo's Acres Dog Training does it's very best to keep all dogs healthy. I understand Enzo's Acres Dog Training is NOT responsible if my dog gets sick in their care. I understand Enzo's Acres Dog Training is NOT responsible if my dog gets hurt and or needs any kind of medical assistance in their care. I understand that that I have read all the FAQ and agree to the terms within the page http://www.enzosacres.com/faq/.

Sign here stating you understand all the terms above. *

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