Valley Gate Labradors

               Customer info

Owner’s Name-________________________________

          Address-_________________________________

                        _________________________________

          Phone#  ______________________

           e-mail-_______________________

Emergency Contact-_____________________________

(name and Number)

Dogs Name-_____________________

         Breed-__________________              Color-__________________

            Sex-__________________              Drop off date-____________

             (if female please put last heat cycle)                 (VGL portion)

Spayed/Neutered Y/N-____                         Pick-up date-____________

                                                                   (VGL portion)

Permanent Identification-__________________

(microchip# or tattoo)

Veterinarian’s Name-________________________________

Phone#-_____________________

For the safety of our dogs and others boarding with us

current Proof of Rabies, DHLP-Parvo and Bordetella Vaccinations

MUST accompany the dog at time of drop off.

Comments:

(Please use this space for any further information you feel would help us care for your dog such as any medications, temperament issues and regular feeding schedule)