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Owners Name ________________________________________________________________

Arrival Date _________________________  Departure Date __________________________

Phone # _____________________ Cell # ___________________ Other _________________

Pets Name(s) _________________________________________________________________

Breed __________________________________________ Age _________________________

Emergency contact other than yourself ____________________________________________

Phone # ____________________ Work # __________________ Cell# __________________

CREDIT CARD # (Mandatory)                 VISA or MASTERCARD ONLY

# _____________________________ EXP DATE _____________ CRV # _________

Dollar Amount: (minimum of $200.00 required)  ____________________________


I authorize Add-En-On Kennels to seek emergency medical attention for my pet(s).  I understand that an emergency surgery for "GASTRIC TORSION" as an example is very costly starting at $2500.00 and can range upwards of $ 6000.00.  I furthermore take full responsibility for my pets medical expenses and authorize treatment, surgery and if necessary, euthanasia.  I authorize and give my permission for Add-En-On Kennels to discuss and/or receive my pets medical records, or discuss the medical condition at hand on my behalf.



Owners Signature_________________________________________________ Date _________