Self-Declaration Form

I declare that my pet…………………… is of ………………………. Breed Male/ Female dog will be

boarding in Pet wags Facility between …………………. to ………………. Dates.

I accept that because of the last-minute decision I have told Pet wags that I will not be able to submit the
doctor’s certificate and consider this as one of exception.

I also declare that

1. My Dog is not suffering for any Ticks and Flea

2. My last day of deworming was ………………….

Please mention details if deworming is required during the stay

3. My dogs doesn’t have any skin infection. Yes/ No

Please mention if any skin problem is there and any medicine we need to apply for the same

4. My dogs don’t have any eye infection. Yes/ No

Please mention if any eye problem is there and any medicine we need to apply for the same

5. Please mention the last date of the below mentioned vaccine

 DHPII _______________________

 Rabies_______________________

 Corona______________________

 Kennel Cough/Bordetella____________________

 Other________________________

Any upcoming Vaccination___________________

6. General information
  Previous Medical History

 Any Medication or follow up

 Allergies, if any

I self-declare that the dog is ok to board in your facility

Name: ________________________________

Signature:______________________________

Place: ___________________________

Date: ___________________________