Owner's Agreement Owner InformationOwner's Name* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* How did you hear about Wag Resort Website (wagresort.com) Veterinarian* (see below) Newspaper Booth / Exhibit Personal Recommendation Other* (see below) * If you selected Veterinarian, who can we thank for the referral? * If you selected Other, please list here. Emergency ContactEmergency Contact Name* Emergency Contact Phone*Dog InformationDog #1Name Breed Color Sex Male Female Spayed / Neutered Yes No Birthdate Weight Current medications or medical problems (including allergies) Another Dog Add another dog Dog #2Name Breed Color Sex Male Female Spayed / Neutered Yes No Birthdate Weight Current medications or medical problems (including allergies) Another Dog Add another dog Dog #3Name Breed Color Sex Male Female Spayed / Neutered Yes No Birthdate Weight Current medications or medical problems (including allergies) Veterinarian InformationName Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneBehaviorWhat are the specific behaviors you're trying to correct at this time? How well does your dog socialize with unknown dogs? How well does your dog socialize with unknown people? Has your dog ever bitten a person or animal causing injury? If yes, please explain: Does your dog have exercise limitations? Has your dog ever jumped or climbed over a 6 foot fence? Yes No Terms and ConditionsBy checking this box I agree to the following Terms and Conditions relating to the daycare, boarding, grooming, training or transportation of one or more of my dogs at HHPR, LLC dba Wag Resort.* I agree Terms and Conditions for Services Provided by the Wag Resort
