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Self Declaration Form (Main Form)

This document is a self-declaration form for boarding a pet dog at Pet Wags Facility. It states that the owner's dog is a [breed] that will board from [dates]. It also acknowledges that veterinary certification will not be provided due to a last minute decision. The owner declares that the dog has no ticks, fleas, skin infections, or eye infections. It provides vaccination dates and any upcoming vaccinations. General health information is also disclosed around previous medical history, medications, allergies. The owner signs to self-declare the dog is okay for boarding.

Uploaded by

Ravi Magroriya
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513 views2 pages

Self Declaration Form (Main Form)

This document is a self-declaration form for boarding a pet dog at Pet Wags Facility. It states that the owner's dog is a [breed] that will board from [dates]. It also acknowledges that veterinary certification will not be provided due to a last minute decision. The owner declares that the dog has no ticks, fleas, skin infections, or eye infections. It provides vaccination dates and any upcoming vaccinations. General health information is also disclosed around previous medical history, medications, allergies. The owner signs to self-declare the dog is okay for boarding.

Uploaded by

Ravi Magroriya
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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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: ___________________________

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