Camp Canine | New Client Registration Form

The form below is for new clients only. If you're already a client of Camp Canine, please click here to request an appointment.

Camp Canine New Client Registration Form

To prove you're a real person (and not a SPAM bot), please check the I'm not a robot box below.

The Google SPAM test above works with Chrome, Safari, Firefox and Microsoft Edge browsers, not Internet Explorer.

Please sign the wavier that will be emailed to you at the approval of your new client form.

Owner Information

First Name *Required*

Last Name *Required*

Phone Number *Required*

Email *Required*

Address

City

State | Province

Zip Code | Postal Code

Family Vet Clinic

How did you find us?

Emergency Contact (Include Phone Number)/Others Allowed to Pick Up

Owner Question #1: Do you want your dog bathed or nails trimmed during their stay?

Owner Question #2: If you have multiple dogs, do you want them to stay in the same kennel or separate?

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description

Date of Birth

Camp Canine requires proof of vaccination.

Rabies Expiration

DHPP Expiration

Bordetella Expiration

Leptospirosis Expiration

Influenza Expiration

Microchip Code

Weight

Insurance Info

Feeding Notes

Medication Notes

Temperament Notes (Aggression, anxiety, etc? If extensive, tell us in person).

Additional Notes (Anything else we should know? If extensive, tell us in person.)

Pet Question #1: Does your dog have anxiety in the from of barking, digging or chewing?

Pet Question #2: Does your dog have any allergies?

Pet Question #3: Is your dog ok with kids?

Pet Question #4: Does your dog like other dogs?

Pet Question #5: Is your dog a fence jumper?

Mobile Phone Alert: Some phones have difficulty uploading the files below (the form gets reset after uploading). If this happens on your phone, please submit this form using a computer. You can also submit this form on your phone without uploading anything and then email your pet picture and vaccine verification document to us at campcanine23@yahoo.com. Thanks!

Pet Photo (Not Required. 5MB Max. Image Files Only)
Click to Upload Pet Picture

Proof of Vaccinations (5MB Max. Only Images, No PDFs. Take a Picture of Document with Your Phone and Upload It.)

Click to Upload a Picture of Proof of Vaccinations

Click Here to Add a Second Pet

Click Here to Add a Third Pet

ALERT: If you have more than three pets, submit this form once with your first three pets. After submitting the first time, click the link to come back to the form (shown after you submit the form) and fill out this form again with the information for your other pets. The second time you fill it out, you only need to include your name, phone and email in the OWNER section because the business will already have the other info (address, emergency contact, etc) from the first time you submitted the form.

Pet #3 Information