Date in: _____________________________ Date of Pick-Up:____________________________

Owners First Name: ____________________ Last Name: _______________________________

Home Phone: _________________________ Cell Phone: _______________________________

Work Phone: _________________________ Emergency Phone: _________________________

Street Address: _________________________ City: _____________________ Zip: _________

Email Address: _________________________

Dog (1) Name: ______________Breed: ___________ Color: _________Sex:_____ Age: _____

Dog (2) Name: ______________Breed: ___________ Color: _________Sex:_____ Age: _____

Food & Medication (if any) Received with Dog(s), Instructions:___________________________

____________________________________________________________________________

I, release all liability from Stone’s K9 Boarding Facility 1275 Delta Road, Knightsen California 94548. In case

of injury, accident or illness, I do understand that Stone’s K9 Boarding Facility will take the very best care of

my dog(s) and every precaution for the health and welfare of my dog(s).

If the dog(s) becomes seriously ill the Owner shall be notified at once. If the Owner does not inform

immediately regarding measures to be taken, or if the state of the dog(s) health reasonably demands quick

action, we shall have the right to call a veterinarian of choice or administer medicine or give other advisable

attention, within our discretion and judgment. Owner will refund any and all expense incurred promptly.

Owner specifically represents to kennel that dog(s) have not been exposed to rabies or distemper within a

30 day period prior to boarding. All vaccinations including rabies, distemper, and bordatella are current, flea

control is used and the required annual license has been obtained from the county in which the dog(s) and

Signed: _____________________                                Signed: ________________________

                      Owner of Dog(s)                                                                                          Kennel Owner

Upon pickup of the Dog(s) listed above. Owner shall sign below confirming that the Dog(s) were received back
in good condition on the date written below. This is to be filled out as a receipt for kennel records by the Owner
of the Dog(s).

Signed: ___________________                                 Date: __________________

                     Owner of Dog(s)                                                                              Date of Pick-up