Contact Info  Phone: (518) 456 0700  Fax: (518) 456 0782
email:
gregmiller@pinebushkennels.com                                                                                                          * = required

* First Name
* Last Name
Street address
Address(con't)
City
State/Province
Postal code
 
* E-mail
* Day Phone

Night Phone

Veterinarian
   
Veterinarian's Phone Number
   
Emergency Contact's Name

Emergency Contact's #


I would like space for

* Pet 1

Pet 2
Dates Start

End


Special Instructions
Medications

Feeding

Exercise

Other


Grooming
 
Please Groom

Comments/
Questions

NOTE: INNOCULATIONS REQUIRED
To guard the health of our canine and feline guests, we require proof that your dog has been inoculated against rabies, distemper and parvo virus. Certification is required prior to admittance and must be current. If your cat will be staying with us, we must have proof that he or she has been innoculated against rabies, distemper, rhinotracheitis and calici virus