1. Kennel Drop Off*

   Please nominate when you will be dropping your dog into the kennel

2. Time* Please select... 8.00am - 8.30am 4.00pm - 4.30pm
3. Kennel Pick Up*

   Please nominate when you will be collecting your dog from the kennel

4. Time* Please select... 8.00am - 8.30am 4.00pm - 4.30pm
5. Name of the dog
6. Sex of the Dog* MaleFemale
7. Dog breed*
8. Registration number*
9. Date of vaccination expiry*

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

10. Your dog vaccination certificate*

    Please attach a copy of dog vaccination certificate. PDF only, maximum file size 10Mb.

11. Does your dog require heart worm tablets* YesNo

    Please select one of the following options

12. Does your dog require any other forms of medication? Please provide details:*

    Please type yes or no in the box. If yes please list type of medication and quantities

13. Additional veterinary treatment* YesNo

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

14. 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
15. Contact Name*
16. Email*
17. Contact Number*
18. Address*

* denotes a required field.