New student registration form

773-533-5959

Current Students

Prospective Students

New Student Registration

Owner information

* required field

First Name:

Last Name:

Email:

*
will serve as your user ID

Assign your Password:

Re-key your Password:

I agree to receive updates and special offers by email from K9U

Address:

City:

* zip: *

State:

Home Phone:

Cell Phone:

Work Phone:

Co-owner's information

First Name:

Last Name:

Email:

I agree to receive updates and special offers by email from K9U

Home Phone:

Cell Phone:

Vet information

Veterinary Clinic Name:

Veterinary Clinic Phone:

Used our services before?

yes no

if no, how did you hear about us?

Services requested

(check all that apply)

boarding daycare training

Dog information

How many dogs are you registering?

Dog 1
Name:	*
Breed:	*
Color:	*
Weight:	*
Birth date:	*
Gender:	*
Upload picture of dog: (optional)	1Mb max size
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no *
Brand of food:	*
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no *
Get along with all other dogs?	yes no * if no, please explain

Dog 2
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)	1 Mb max size.
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 3
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)	1 Mb max size
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 4
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 5
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 6
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 7
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 8
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Dog 9
Name:
Breed:
Color:
Weight:
Birth date:
Gender:
Upload pictture of dog: (optional)
Would you like to post your dog’s picture within Student section of this website?	yes no
Spay/neutered?	yes no
Brand of food:
Allergies:
Medical issues:
Special needs:
Exercise with other dogs?	yes no
Get along with all other dogs?	yes no if no, please explain

Required Vaccinations

All dogs boarding or doing daycare at K9 University must be vaccinated. Please confirm your dog(s) has the required vaccinations by checking the boxes below.

Distemper / Parvo,
expiration date: * (mm/dd/yyyy)

Rabies *

Bordetella *

Please bring a copy of all required vaccinations when you drop off your dog(s)

Terms and Conditions

This above form serves as my contract and authorizes any appropriate, necessary, urgent or emergency veterinary care to be performed on my animal(s) while under the care of K9 University and/or their designees. Under the terms of this agreement, I agree to be wholly responsible for any and all expenses incurred in the administration of necessary, urgent or emergency veterinary care. I accept full responsibility for my dog's behavior while at K9 University.

* Check this box to agree to these Terms and Conditions

* Check here to confirm you understand that K9 University is not responsible for any personal items such as toys, bedding, bowls, food, treats or other items that you leave with your dog.

* type security code