WEST LINN Intake Form

Name *

First Name

Last Name

Additional Parent Name

First Name

Last Name

Cell/Contact Phone *

(###)

###

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Emergency Contact Phone *

(###)

###

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Ok to send emails?

Yes

No

Birthdate *

MM

DD

YYYY

*

I acknowledge that my dog must be up to date on their vaccines and proof from my vet needs to be emailed to: info@safeandhound.net before my dog’s Evaluation Day can be scheduled

*

I have read and agree to the Safe & Hound Daycare Agreement

I have read and agree to the Safe & Hound Rules