Retriever Training - Gun Dog Training - AKC-UKC Hunt Tests - Obedience Training - "Let my Kennel  make your next hunting partner "the best you have ever had"!
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Please download the attached form and bring with you when you drop off your dog

stillwater_information_sheet.docx
File Size: 40 kb
File Type: docx
Download File

Date Form Completed :___/___/___


 DOG NAME:




*****************************************************************************************************
Information in this below to be filled out by Stillwater Kennels LLC


 __Shot Record Received
 __Heartworm Medicine Due Date of Month (i.e. 19th)
 __Flea/Tick/Dewormer Due Date of Month 
 
*****************************************************************************************************

Owner’s Name:____________________________________________ 
 
Owner’s Address: __________________________________________
_________________________________________________________
_________________________________________________________

Home Phone:__________________ Cell Phone:__________________

____Yes, I can receive text messages

Email Address:_____________________________________________

Emergency Contact:_________________________________________
                                                          (Name)

_________________________________________________________
 (Address)

_________________________________________________________
 (Phone) 


Health Information


Veterinarian:______________________________________________

________________________________________________________
(Address)

________________________________________________________
(Phone)



 



Page  2 ---------------------------------------------------------

 



  
 
Dogs Name:___________________________________________________

Shot’s Completed:
_____________________________________________________________
(Date) 
 
Health Problems:_______________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Food

Type of Food:__________________________________________________

How Many Times a Day:__________________________________________



Medication, Allergies, Special Instructions

Please list all medications, allergies and special instructions in the following:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
 


We will give you permission to authorize emergency medical care for our pet(s) as
deemed necessary by a veterinarian, and understand that we will be responsible
for full payment and care of our pet(s).

_______ Yes _______ No

Owner Signature___________________________________Date______________

'Let my kennel make your next hunting partner 'the best you have ever had'!