Online Form - Dog Kennel Application Form

Kennel Drop Off *

Drop Off Time *

Kennel Pick Up *

Pick Up Time *

Name of dog

Sex of the Dog *

Male
Female

Dog breed *

Registration number *

Date of vaccination expiry *

Dogs will not be permitted in the kennel unless proof of vaccination has been sighted by the Kennelling Officer.

Your dog vaccination certificate *

Does your dog require heart worm tablets *

YesNo

Does your dog require any other forms of medication?

YesNo

I authorise the Shire Ranger and Kennel Keeper to proceed with any veterinary treatment if circumstances deem it necessary *

YesNo

Terms & Conditions

I acknowledge and understand the above conditions and agree that whilst the Shire will take care of my dog, I will not hold the Shire of Ashburton responsible for any loss, injury, ailment or death that befalls my dog during the period of kennelling.

I have read and agree to the Terms and Conditions *

Yes, I have read and agree to the Terms and Conditions

Contact Name *

Email *

Contact Number *

Address *