Please fill out the form below to register your dog with Stay. This form needs to be completed only once, but please fill out a separate form for each dog if you have more than one. Required fields are indicated by *.
 

Owner Information
First Name*
Last Name*
Address*
Apartment/Suite
City*
State/Zip*
Home Phone*
Cell Phone*
Work Phone
Email Address*
Emergency Contact Information
(different from person listed above)
First Name*
Last Name*
Home Phone*
Cell Phone*
Work Phone

Dog Information
Dog's Name*
  Female  Male
Breed
Weight lbs   oz
Color/Markings
Birthdate
Microchip #
(if available)
Spayed/Neutered? Yes  No

Veterinary Information
Vet Hospital Name*
Phone Number*
Address
City
State/Zip

Vaccination Information
Please ask your veternarian to fax your dog's vaccination records to Stay at 773.509.0050. Required vaccinations are shown and must be current at time of check-in. The Titer Test may be substituted for distemper and parvovirus vaccinations.
Distemper Yes  No
Rabies Yes  No
Bordetella Yes  No
Parvovirus Yes  No
Heartworm Test Yes  No
Titer Test Yes  No
Have vaccination
records been
submitted to Stay?		 Yes  No

Medical Information
Does your dog have any allergies?
Yes  No
If yes, please specify:
Does your dog have any injuries or health concerns?
Yes  No
If yes, please specify:
Is your dog taking any medications?
Yes  No
If yes, please specify:
Will Stay need to administer these medications?
Yes  No

Food and Diet
My dog eats
Breakfast
Lunch
Dinner
Serving size cups
Brand of food
supplied to Stay
If no food supplied, I agree that my dog can receive Wellness brand food
Yes  No
Special feeding instructions?
Yes  No
If yes, please specify:

Boarding and Daycare History
Has your dog been boarded before?
Yes  No
If yes, where?
Has your dog been in daycare before?
Yes  No
If yes, where?
  or