Connie Winters’ Kennels, Inc., The Vacation Spa for Pets   Please answer all questions completely to help us understand your pet and keep him (her) healthy, happy and safe   Or, click here to download and print the registration form.    Owner’s Name: Street Address: City, State Zip: Home phone: Cell Phone: E- Mail address:  * required  * required Emergency phone: Emergency contact person: Pet Information Pet’s Name: Breed /or combination: Color(s): Sex: Spayed: Neutered: Type of Pet: Date of birth: Month: Day: Year: Weight: Health problems: Vet: PA State Dog License # (required unless dog has an out of state address): Medications (must be labeled pet’s name/ dosage): Vaccination Record (give  date- must be current): DHLP-P: Bordetella: Rabies: Feline Leukemia: CCRP: Medications: Special Instructions: Labeled Possessions: Regular brand of food: Amount: Time of meal(s): What is your pet’s favorite toy?: Pet’s favorite past time?: How long is your pet alone?: Pet’s exercise schedule?: Does your pet live with: Children Dog Cat Other Only with owner Is your pet afraid of: Loud Noises Thunder/ Lightning Other Animals Men Women List of Other Fears Has your pet ever shown aggressive behavior towards: Humans Animals Please explain: Has your pet ever bitten anyone or another animal: Details: Has your pet ever shown any destructive behavior: Explain:   SPA AND LODGING SERVICES REQUESTED Deluxe Suite Lodging pkg. Standard Lodge room Bunk Bed room Breakfast in Bed Dispense Meds Day care Doggie Camp--Group Play Time Individual Extra Exercise Session Complete Spa grooming Bath and Nails Only Pedicure Flea/ Tick treatment Cuddle Time \ tummy rubs Pool Time Nature Hike Obedience Training Single Cat Room Townhouse for Cat(s) Contract         Connie Winters’ Kennels, Inc., The Vacation Spa for Pets Important! Please Read Carefully! Connie Winters’ Kennels, Inc. agrees to exercise due and reasonable care and to keep kennel   premises sanitary and properly enclosed.  The pet will be properly and regularly fed, watered, exercised and housed in clean safe quarters. All pets are boarded, groomed, trained, or otherwise cared for by Connie Winters’ Kennels, Inc. without liability on the part of the kennel for loss or damage from disease, death, running away, theft, fire, injury to persons, other pets, property by said pet, or other unavoidable causes, due diligence and care having been exercised.  It is expressly agreed, by the Pet Owner and the Kennel that the Kennel’s liability shall in no event exceed the lesser of the current chattel value of a pet of the same species or the sum of $200.00 per animal.  Pet owner agrees to pay Connie Winters’ Kennels, Inc. for all services rendered, at the kennel’s current rates. Payment is due no later than the above scheduled time that pet is to be picked up from the kennel.  Owner agrees that if animal is not retrieved within five (5) days of the above scheduled discharge date, and no contact has been made with kennel, by pet owner, animal will be considered abandoned.  Kennel may dispose of animal by sale or otherwise, at the kennel’s discretion.  Owner will be notified by certified mail at the above address and owner will be held responsible for all charges for services rendered and all charges related to disposal of abandoned pet. Owner further agrees that the pet will not be released to the owner, from the kennel until all charges are paid to the kennel.  Pet Owner agrees that kennel may provide veterinary services or administer medications if needed in the kennel’s judgment.  Kennel will attempt to contact above designated veterinarian but will contact another veterinarian or emergency veterinary hospital if kennel deems necessary.  Pet owner agrees to reimburse kennel for all related costs, including veterinary costs, travel expenses, and staff time.  Kennel will attempt to contact pet owner but will contact and take animal to a veterinarian if deemed necessary. Pet Owner certifies that animal has not been exposed to any infectious diseases within 30 days.  Owner is responsible for notifying kennel of any health related issues or exposures, both prior to and after departure from the kennel.  If a pet,  which is presented to kennel for any service, is found to have fleas and/ or ticks, it will be treated at the owner’s expense.  Pet Owner’s signature: Date: Connie Winters’ Kennel, Inc., Representative: