Details About YouName* First Last PhoneEmail* Emergency Contacts & PermissionsPlease provide two contacts in the unlikely event we are unable to contact youName*Phone*Relationship*NamePhoneRelationshipMay we have your permission to send you occasional updates on our services?*YesNoWould you like to see your pet on Facebook while you’re away?*YesNoMay we post photos of your pet on Facebook page at www.facebook.com/WinghamNSWPetMotel and for publicity in media such as magazines, websites and newspapers?*YesNoDetails About Your PetVeterinary CareName of Veterinary PracticeContact NumberAddress (if not Taree or Wingham)Other DetailsDoes your pet have any behavioural issues, fears or phobias e.g. storms, thunder?Anything that causes aggression e.g. biting, other dogs, wary of men/women? Escape artist?What are your pet’s favourite games or toys?Do you give your permission for your dog to:Be carefully mixed with other dogs during supervised free running time?YesNoGo on leashed walks outside of the kennel enclosure – inside our home and home gardens?YesNoIs your pet house trained?YesNoFoodAny dietary requirements and or food intolerances?Is it OK to feed your pet: Raw meaty bones Chicken necks Kongs Other puzzles What are your pets favourite treats?MedicalIf we have not seen proof of vaccinations before check in we may not be able to board your pet.Vaccination CertificatesDoes your pet have any current medical conditions?If yes, please stateWhat date was your pet last given a gastro intestinal wormer? Please advise us of your approximate check in/check out timeWithin our hours 8am-11am & 4pm-6pm HH : MM AM PM Any other comments, requirements or information:After your pet’s stayIf you would like to write a review on your pet’s stay, go to the reviews section at: www.facebook.com/WinghamPetMotel/reviews Thank you. Terms and Conditions of Boarding By signing this form, you, the owner/guardian of the above pet(s), give permission for Wingham Pet Motel to care for your pet and to make all decisions about your pet during their stay. You give your permission for your vet(s) to release all information about your animal(s) to Wingham Pet Motel, now and in the future. While all precautions and care will be taken, you agree to pay for all veterinary & any other expenses (such as administering medication and transport to vets) incurred during boarding. In an emergency, we would take your dog to the nearest vet without notifying you or your emergency contacts. If medical intervention is required, you agree to permit our vet to perform the highest level of emergency veterinary care. Dogs must have proof of at least 90% effective tick/flea preventatives. You give us permission to administer tick or flea preventatives if necessary, & add this to your bill. Our costs for these and other extra services are posted in the office. Cats must be on regular Bravecto spot on flea and tick treatment. Any evidence of fleas on check in will require your cat to be placed in our quarantine which will incur additional fees. Payment is per day so your pet can be checked in/collected any time of that day (within our hours) and your rate will be the same. Payment is required on check in. We require all prescribed medication to be in the original vet or pharmacist packaging. Failure to disclose your pet’s special requirements or behavioural issues on this form may result in an increased boarding rate and/or veterinary fees. Cancellation Policy Should you need to cancel your pets’ holiday With more than one month’s notice, we can offer you a credit to be taken at a future booking within 6 months, less a $35 booking fee With less than one month’s notice, we can offer you a credit to be taken at a future booking within 6 months, less a $100 booking fee at Christmas, $50 at other times of the year By signing this, you agree to the above terms and conditions. Thank you and we look forward to giving your pet our best possible holiday experience.*Use your finger or mouse to sign your signature as best you canName First Last Date CommentsThis field is for validation purposes and should be left unchanged.