<p> Cozy Cats and Dogs </p><p>Pension de luxe pour chat et chien</p><p>Drop off Date: Time: Collection Date: Time: </p><p>Owners details: Name Address </p><p>Telephone number Emergency number Email Address </p><p>Pet Details: Name: Sex: Age: Breed: </p><p>Microchipped Yes or No Vaccinations up to date Yes or No Flea Treatment up to date Yes or No Neutered/Spayed Yes or No Any Allergies Yes or No Any Health Problems Yes or No Any Medication Yes or No Any special feeding instructions Yes or No Any special requirements Yes or No Do you give permission for us to socialise your dog with other dogs Yes or No Has your dog ever bitten a person Yes or No Has your dog ever shown aggression towards people Yes or No Can your dog jump 1.4m fence Yes or No Would you like additional dog walking (10min €3 or 20min €5 per dog) Yes or No </p><p>I agree that in the case of illness or suspected illness, a veterinary surgeon will be consulted and may be called into carry out such treatment as he considers advisable. I also give permission for worm/flea treatment to be given if necessary. I agree to Cozy Cats and Dogs administering any prescribed treatments and any investigatons that the vet considers necessary (e.g Blood tests, xrays) I also give consent for euthanasia should this be recommended on humane grounds by the vet caring for my animal, in consultation with my own vet/my contact person. I agree that all treatments will be at my own expense. Cozy Cats and Dogs only take animals that are microchipped, as this is a legal requirement. Finally, while every care and precaution is taken by the management of Cozy Cats and Dogs, responsibilty can only be acepted at the owners risk.</p><p>Owners Name ...... </p><p>Owners Signature: ...... Date...... </p>