Application - Billl of Health

For the safety of all dogs attending day/playcare and sleepovers at It's A Dog's Life, we require they be in good health and adequately protected against diseases. Please complete this entire form and return it to us your first day of day/playcare. This form or computer print out from your vet's office must be completed and presented before temperament test can be done.

DOG'S NAME: _________________________________________________________

OWNER'S NAME: _______________________________________________________

VETERINARIAN'S NAME: _________________________________________________

CLINIC NAME: ________________________________________________________

CLINIC TELEPHONE NUMBER: ____________________________________________

CLINIC ADDRESS: _____________________________________________________

In order for your dog to be admitted to day/playcare and/or sleepovers, please have your veterinarian complete and sign the following OR provide a computer print out with proof of shots and expiration dates on vet's letterhead for our files. Future updated documentation required.

I certify that the dog named above is in good health and, as appropriate for age, has received all necessary vaccinations below:

• ANNUAL BOOSTER expiration date: ___________________________
• RABIES expiration date: ___________________________
• BORDATELLA expiration date: ___________________________
• DATE: SPAY or NEUTER: _______________________________________

VETERINARIAN'S SIGNATURE: ____________________________________
DATE: _____________________