Country Barn Dog Kennel LLC New Client Registration Form

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Please complete the forms below to your fullest extent. We will contact you if additional information is required.

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

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description

Date of Birth

Country Barn Dog Kennel LLC requires proof of vaccination.

Rabies Expiration

DPP Expiration

Bordetella Expiration

Vaccine #4 Expiration

Vaccine #5 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.)

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 countrybarndk@gmail.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

Appointments & Bookings: If you want to request an appointment or booking with this business, click here to add those details.

REQUIRED: To prove you're not a SPAM robot, what does 2+2 equal?

If the form does not submit, please scroll up and make sure all required pet and owner fields are filled in. If the issue persists, send an email to countrybarndk@gmail.com

Country Barn Dog Kennel LLC New Client Registration Form

Owner Information

Pet #1 Information

Pet #2 Information

Pet #3 Information