Registration Form – The Green Bone

Name : *

Best contact Number : *

Email : *

Address : *

Where is your place of employment? : *

May we contact you at work? : Yes No

Work Phone :

How did you hear about us? :

Emergency Contact : *

Relation : *

Address : *

Phone : *

Pet Name : *

Breed : *

M / F : * M F

Spay/Neutered? : Yes No

Age : *

DOB : *

Weight : *

Color : *

Allergies / Medical Conditions : *

Pet #2 Name :

Breed :

M/F : Male Female

Spay/Neutered? : Yes No

Age :

DOB :

Weight :

Color :

Allergies / Medical Conditions :

Current Vet : *

Phone Number : *

Doctor's Name :

If my pet becomes ill or injured and neither my emergency contact or I can be reached, I request The Green Bone take my pet to: : *

Address : *

Doctor's Name :

Phone Number :

If needed, I authorize The Green Bone to approve veterinary treatment up to : *

The following person has permission to pick up my dog from daycare or boarding : *

The following person has permission to pick up my dog from daycare or boarding :

I will assume full responsibility upon my return for payment or reimbursement for veterinary services rendered up to the above stated amount. If the veterinary office is closed I give my permission to The Green Bone to take my pet to another veterinary clinic for treatment. Furthermore, I understand that my pet will not be released to anyone other than the authorized persons listed above. It is my responsibility to keep my emergency contact information up to date: : *

Date :

We frequently take photos of our guests to put on our Facebook page and the TGB website. If you DO NOT want your pet(s) participating in photos or want us to share your pet(s) photo(s), initial here to DECLINE: :

By using this form you agree with the storage and handling of your data by this website

Registration and Evaluation