owner & dog registration

Please fill out the form below to register your dog with Stay. This form needs to be completed only once, but please fill out a separate form for each dog if you have more than one. Required fields are indicated by *.

Owner Information
Name*
Address*
Apartment/Suite
City*
State*
Zipcode*
Home Phone*
Cell Phone*
Email*
Work Contact Information
Company Name*
Address
Suite
City
State
Zipcode
Work Phone*
Emergency Contact Information
(different from person listed above)
Name*
Home Phone*
Cell Phone*
Work Phone*
Dog Information
Dog's Name*
Gender
Breed
Weight
Color/Markings
Birthdate
Microchip # (if available)
Spayed/Neutered
Veterinary Information
Vet Hospital Name*
Phone Number*
Address
City
State
Zip
Vaccination Information
Please ask your veternarian to fax your dog's vaccination records to Stay at 773.509.0050. Required vaccinations are shown and must be current at time of check-in. The Titer Test may be substituted for distemper and parvovirus vaccinations.
Distemper
Rabies
Bordetella
Parvovirus
Heartworm Test
Titer Test
Have vaccination records been submitted to Stay?
Medical Information
Does your dog have any allergies?
If yes, please specify
Is your dog taking any medications?
If yes, please specify:
Will Stay need to administer these medications?
Does your dog have any injuries or health concerns?
If yes, please specify
Food and Diet

My dog eats
Serving size (in cups)
Brand of food supplied to Stay
If no food supplied, I agree that my dog can receive Wellness brand food
Special feeding instructions
Boarding and Daycare History
Has your dog been boarded before?
If yes, where?
Has your dog been in daycare before?
If yes, where?
Does your dog play well with other dogs?
If yes, please indicate size and breeds he or she prefers