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Print out this form and complete.
Send to:
Judy Chisholm
P.O. Box 803
Green Valley, AZ 85622
Pets
name:______________________________________________
Breed:
______________________________________________
Age:
_________________
Sex:
_________________
Spayed/neutered?
5Yes
5No
Special Diet?
5Yes
5No
Other special needs? If "yes" briefly
explain
____________________________________________________________________________________
____________________________________________________________________________________
Your name:
_____________________________________________
Address:
_____________________________________________
City:
_____________________________________________
Phone:
_____________________________________________
Email:
_____________________________________________
Signature:
______________________________________________
Emerg. #
______________________________________________
Vet Info & number
_____________________________________________________________________
* Owner will be
responsible for any/all vet bills incurred
due to illness.
* Because of liability I reserve the right
to refuse any animal.
* There will be a service charge of $10 per
day for any un-altered animal, puppies
excluded.
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