Primary Owner *

First Name

Last Name

Secondary Owner/Emergency Contact

First Name

Last Name

Primary Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Phone *

(###)

###

####

Secondary Phone/Emergency Contact

(###)

###

####

Current Veterinarian Phone *

(###)

###

####

Current on Vaccinations *

We require all dogs to be up to date on their vaccinations. If you checked "no" you will need to obtain the appropriate vaccinations before your dog(s) stay.

yes

no

Spayed/Neutered *

yes

no

I (primary owner) agree to the following: *

In the case of an emergency, I understand that TNT will make every attempt to contact the primary owner, secondary owner

If no contact can be reached. I authorize TNT to seek appropriate medical treatment for my dog(s). I understand that every effort will be made to take my pet(s) to the above Veterinarian, however, I authorize TNT to seek treatment for my pet(s) at the appropriate clinic.

I authorize TNT and the Veterinarian caring for my pet(s) to share all
 medical records of my vet(s) with emergency vet clinics in an effort to provide the 
best care possible.

I agree to assume full responsibility for payment and reimbursement to TNT for any and all veterinary services rendered.

I agree to provide current vaccination/vet records if requested.

I agree that the above information is correct to the best of my knowledge

Date

MM

DD

YYYY