Boarding Form Please fill out the boarding form: Boarding Form Step 1 of 2 50% Client Name:(Required) First Last Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date you want to drop off your dog:(Required) MM slash DD slash YYYY Date you want to pick up your dog:(Required) MM slash DD slash YYYY Drop off time(Required) 9 AM 6 PM Pick up time(Required) 9 AM 6 PM Email(Required) Phone(Required)Alt PhoneDogs Name(Required) Breed(Required) Age(Required) Weight(Required) Male/Female(Required) Male Female Spayed/Neutered:(Required) Yes No Medications: (Medications must be in original vial with veterinarian’s administering instructions. )(Required) Yes No Food Brand and Feeding Instructions: History, Behavior, Current Issues: Please check all that apply.(Required) My dog sleeps in a crate at home or when required. My dog is an Alpha Dog. My dog runs away if left off-leash. My dog is afraid of thunder and lightening. My dog plays well with other dogs. My dog has allergies. My dog has separation anxiety. My dog can climb fences. Other Important information:(Required) By signing this consent I authorize Dale Parker and JCK employees to obtain emergency medical services for my dog during my dog’s stay at JCK. I understand that Dale will make every effort to contact me prior to seeking medical attention for my dog. Dog's name(s)(Required) Add RemoveThese services may include veterinarian visits, x-rays, surgery, bandages, and euthanasia as deemed necessary by the veterinarian. The cost of these services must not exceedAmount(Required) Unlimited Specify Amount Please specify maximum amount(Required)Sould the costs exceed the amount indicated here I understand that Dale will contact me to make plans for my dog’s care until I return. In the event that, despite all JCK and veterinarians can do, your dog passes away during its stay, they will be taken to our vet for cold storage until your return.(Required) I agree I disagree Would you like your dog to play with other dogs? During your dog’s stay at JCK they will have the opportunity to play and socialize with other dogs of their size and temperament. We are very sensitive to play-appropriate groups (no big dogs with little dogs, old with young, ect.), and will choose an appropriate pack for your dog. I hereby release JCK of all liability resulting in injury or death from such activities. I will be responsible for the medical care of my own dog.(Required) Yes No Dale Parker or Jackson Creek Kennel bears no responsibility, financial or otherwise for any injury, sickness, or disease that may happen to your dog during his or her stay at Jackson Creek Kennel.(Required) I agree I disagree Your Name(Required) Date(Required) MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ
