Owner Information

Name

Home Address

Primary Phone

Secondary Phone

Email Address

Emergency Contact (if owner cannot be reached)

Emergency Phone Number

Pet Name

Breed

Age

Weight

Gender

Spayed/Neutered Spayed/Neutered Yes No

Veterinarian Name

Veterinarian Phone

Is your pet current on vaccinations (Parvo & Distemper)? Is your pet current on vaccinations (Parvo & Distemper)? Yes No

Date of Last Vaccinations

Is your pet currently on mediation? Is your pet currently on mediation? Yes No

If yes, list medication name and dosage instructions

Does your pet have allergies or medical conditions? Does your pet have allergies or medical conditions? Yes No

Has your pet undergone any prior surgeries? Has your pet undergone any prior surgeries? Yes No

* * To provide structured and appropriate supervision, please answer honestly:

Has your pet shown aggression toward: Has your pet shown aggression toward: Other dogs Adults Children

Does your pet have a history of biting? Does your pet have a history of biting? Yes No

Is your pet crate trained? Is your pet crate trained? Yes No

Does your pet experience separation anxiety? Does your pet experience separation anxiety? Yes No

Does your pet chew or destroy items when left unattended? Does your pet chew or destroy items when left unattended? Yes No

Is your pet potty trained? Is your pet potty trained? Yes No

Feeding Schedule

Amount Per Feeding

Food Provided by Owner? Food Provided by Owner? Yes No

Are treats permitted? Are treats permitted? Yes No

Additional care notes or preferences:

Health Oversight & Emergency Authorization Health Oversight & Emergency Authorization I confirm that my pet is in good health and free from contagious illness at the time of drop-off. I confirm that my pet is flea-free upon arrival. I understand that while Nitengale Paws maintains structured supervision, monitored interaction, and controlled environments, normal activity and play may carry inherent risk. In the event of illness or emergency, I authorize Nitengale Paws to seek veterinary care if I cannot be reached promptly. I agree to assume full financial responsibility for any veterinary expenses incurred during my pet’s stay. I authorize transportation to a veterinary facility if necessary.

Boarding Policies & Financial Acknowledgment (I understand and agree to the following) Boarding Policies & Financial Acknowledgment (I understand and agree to the following) Day Care: $50 (up to 10 hours between 5:00 AM – 8:00 PM) $25 per hour late fee after scheduled pick-up Automatic conversion to $85 overnight rate if not picked up by 10:00 PM Overnight Boarding: $85 per night Extended Stay: Minimum 3 nights 5+ nights receive 10% discount I understand that complete behavioral disclosure is required to maintain a safe and structured environment.

Owner Certification Owner Certification I certify that the information provided is accurate and complete. I acknowledge that I have read and agree to the Nitengale Paws Boarding Intake & Care Agreement.

Owner Signature:

Date: