(* indicates a required field)

Pet Information
1st Pet		2nd Pet		3rd Pet
Name *		Name *		Name *
Breed		Breed		Breed
Color		Color		Color
DOB or Age		DOB or Age		DOB or Age
Gender	Male Female	Gender	Male Female	Gender	Male Female
Weight		Weight		Weight
Neutered or Spayed? Yes No		Neutered or Spayed? Yes No		Neutered or Spayed? Yes No
List any preexisting conditions, behavior problems, or special needs for your pet(s):

Food Schedule
Food Type		Food Type		Food Type
Quantity		Quantity		Quantity
Time (Choose all that apply)	Morning Afternoon Evening	Time (Choose all that apply)	Morning Afternoon Evening	Time (Choose all that apply)	Morning Afternoon Evening
Special Instructions		Special Instructions		Special Instructions
Medication Schedule
Medication		Medication		Medication
Quantity		Quantity		Quantity
Time (Choose all that apply)	Morning Afternoon Evening	Time (Choose all that apply)	Morning Afternoon Evening	Time (Choose all that apply)	Morning Afternoon Evening
Special Instructions		Special Instructions		Special Instructions
Owner Information

First Name *

Last Name *

Address

Home Phone

City

Work Phone

State

Cell Phone

Zip

Email Address *

Boarding Information

Arrival Date

Arrival Time

AM PM

Departure Date

Departure Time

AM PM

Referred by

Type of Boarding Requested

Additional Activities Requested (Choose all that apply)

1st Pet		2nd Pet		3rd Pet
Boot Camp Package (Choose 10 Activities below - 5 river walks = 5 activities) OR Pampered Pooch Package (Choose 6 Activities below) Individual Actvities Below Only		Boot Camp Package (Choose 10 Activities below - 5 river walks = 5 activities) OR Pampered Pooch Package (Choose 6 Activities below) Individual Actvities Below Only		Boot Camp Package (Choose 10 Activities below - 5 river walks = 5 activities) OR Pampered Pooch Package (Choose 6 Activities below) Individual Actvities Below Only
(** Activities included in all camp packages)
Activity	QTY	Activity	QTY	Activity	QTY
River Walk		River Walk		River Walk
Garden Walk		Garden Walk		Garden Walk
Frisbee Fields		Frisbee Fields		Frisbee Fields
Agility Playground		Agility Playground		Agility Playground
Extra Cuddle Time**		Extra Cuddle Time**		Extra Cuddle Time**
Board & Train		Board & Train		Board & Train
Bird Watching on the Vermillion		Bird Watching on the Vermillion		Bird Watching on the Vermillion
Campfire Weenie Roast**		Campfire Weenie Roast**		Campfire Weenie Roast**
Diving for Weenies		Diving for Weenies		Diving for Weenies
24 Photos**		24 Photos**		24 Photos**
Grooming (Choose all that apply)
1st Pet		2nd Pet		3rd Pet
Bath & Towel Dry Nails Condition & Blow Dry (Long Coat) Coat Conditioner		Bath & Towel Dry Nails Condition & Blow Dry (Long Coat) Coat Conditioner		Bath & Towel Dry Nails Condition & Blow Dry (Long Coat) Coat Conditioner

Veterinarian *

Vet Phone *

Vet Address

Vet Fax

Vaccination Records

All pets' vaccinations (rabies, distemper parvo, and bordetella) are current now.
All pets' vaccinations will be current before arriving at Starved Rock Pet Resort.

MUST PROVIDE PROOF. Ask your vet to fax records to us at (815) 673-1222

Owner Location during Pet Stay

Owner Contact Number during Pet Stay

Important Note: Your reservation is not confirmed until you receive an email or phone confirmation for the specific dates you have requested.


Security Code*

(* indicates a required field)

Pet Information

Food Schedule

Medication Schedule

Owner Information

Boarding Information

Important Note: Your reservation is not confirmed until you receive an email or phone confirmation for the specific dates you have requested.