Registered Name | Call Name | AKC |
Sire | Dam |
Birth Date | Country | Breeder |
Breed | Color/Variety | Owner |
Rabies.............. |
Parvo............... |
Kennel Cough.. |
DHLPP........... |
Owner | Home # | Work # |
Co-Owner | Home # | Work # |
Friend | Home # | Work # |
Veterinarian | Work # | Emergency # |
In case of emergency, I, , owner of above mentioned dog do here-in give my permission to Cheryl Cates to seek
and provide medical treatment for my dog. I further, here-in accept all responsibility for my dog while in the care
of Cheryl Cates, and/or her assistants. If my dog should bite or other wise injure anyone, any and all, liability for
such shall be my responsibility. |
Signed | Dated |