Details About YouName* First Last Email* Details About Your PetNumber of Pets to board?1 Pet2 Pets3 Pets4 PetsPet 1Pet Name*Pet Breed*ColourDate of Birth/Age*Approx. weight in kilograms*Sex*MaleFemaleDesexed/Neutered*YesNoPet 2Pet NamePet BreedColourDate of Birth/AgeApprox. weight in kilogramsSexMaleFemaleDesexed/NeuteredYesNoPet 3Pet NamePet BreedColourDate of Birth/AgeApprox. weight in kilogramsSexMaleFemaleDesexed/NeuteredYesNoPet 4Pet NamePet BreedColourApprox. weight in kilogramsDate of Birth/AgeSexMaleFemaleDesexed/NeuteredYesNoHow long would you require us to take care of your pet?Start Date Date Format: DD slash MM slash YYYY End Date Date Format: DD slash MM slash YYYY Veterinary CareName of Veterinary PracticeContact NumberAddress (if not Taree or Wingham)Other DetailsDoes your pet have any special requirements? If so please detail:Is your pet sociable with other pets or prefers to be alone?How many positive play experiences with different dogs did your dog have before 16 weeks of age?How many positive play experiences with different dogs did your dog have before 6 months of age?Any negative experiences with other dogs and if so, please detail the incident and breed of the other dog(s). What age was your dog when this occurred?Where does your pet normally sleep?Does 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?Has your pet boarded before?*YesNoDo 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 Certificates*Does your pet have any current medical conditions?If yes, please stateWhat date was your pet last given a gastro intestinal wormer? Date Format: DD slash MM slash YYYY Please advise us of your approximate check in timeWithin our hours 8am-11am & 4pm-6pmSelect a time...8:00 - 8:30am8:30 - 9:00am9:00 - 9:30am9:30 - 10:00am10:00 - 10:30am10:30 - 11:00am4:00 - 4:30pm4:30 - 5:00pm5:00 - 5:30pm5:30 - 6:00pmPlease advise us of your approximate check out timeWithin our hours 8am-11am & 4pm-6pmSelect a time...8:00 - 8:30am8:30 - 9:00am9:00 - 9:30am9:30 - 10:00am10:00 - 10:30am10:30 - 11:00am4:00 - 4:30pm4:30 - 5:00pm5:00 - 5:30pm5:30 - 6:00pmAny other comments, requirements or information:How did you hear about Wingham Pet Motel? If you were recommended by a friend or vet, what is their name?Emergency Contact 1Provide the contact details for someone who you nominate to collect and take responsibility for your dog if you are unable to return collect your dog on the check out dateName*Phone*Relationship*Emergency Contact 2Provide contact details for someone who you nominate to collect and provide temporary care your dog in the unlikely event the Pet Motel needed to evacuate. If you are unable to provide this, you agree to permit the Pet Motel to source emergency accommodation for your pet and you agree to pay any additional fees that may be incurred for thisNamePhoneRelationshipPermissionsMay 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?*YesNoTerms 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. 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 Date Format: DD slash MM slash YYYY PhoneThis field is for validation purposes and should be left unchanged.