Homestead Dogs New Client Registration Form

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Please fill out the form to the best of your ability. Once we receive it, we will send you any Agreement that need to be signed. Don't forget to add your shot records and a photo.

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: What works best for appointments, mornings or evenings during the week?

Pet #1 Information

Pet Name *Required*

Breed (Best Guess) *Required*

Sex *Required*

Color Description

Date of Birth

Homestead Dogs requires proof of vaccination.

Rabies Expiration

DPP Expiration

Bordetella Expiration

K9 Flu (optional) 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 #2: Is your dog an Escape Artist? (from a kennel or over fencing)

Pet Question #3: Any Food Allergies? We like to give treats!

Pet Question #4: Which kennel would you want your dog to stay in? 3ft. x 3ft. or 3ft. x 8ft.

Pet Question #5: What word do you use to get your dog into the crate/kennel?

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 homesteaddogs@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