5201 Virginia Beach Blvd.
Virginia Beach, VA 23462

Map & Directions     Petcare@petcarevb.com

(757) 473-0111

Monday-Friday: 7:30 a.m. - 7:00 p.m.
Saturday: 7:00 a.m. - 1:00 p.m.
Sunday: Closed

Puppy Party Registration

Socializing your puppy is one of the most important steps in raising a happy, well-behaved dog.

PET'S INFORMATION

Pet’s name:

Date of Birth (Month/Day/Year)

Breed:

Color:

Sex


Identifiers

Microchip #:

tattoos:

special marks:

declawed:

AKC #:

Acquired at what age:

Origin:


Has your pet ever traveled/lived out of Virginia?

If yes (States and approximate dates)

Who is your puppy’s veterinarian?

Date of last Vaccination/Deworming:

Deworming:

Bordetella (Kennel Cough):

Canine Distemper/Parvo/Corona:

Rabies:

Name/Date of Flea Preventative: (Month/Day/Year)


Food:

Brand(s):

Treats/Supplements:

Do you currently have Pet Insurance?

If Yes, which company?

Please tell us what you would like to accomplish in this class?


OWNER INFORMATION

Owner Name:

Last Name

Firts Name


MI

Co-Owner :

Co-Owner Name:

Last Name

Firts Name


MI

Mailing Address

Residence Address (if different):

Primary Ph#:

Primary Ph#:

Alt.Ph#:

Alt.Ph#:

Alt.Ph#:

Alt.Ph#:

E-mail :

How did you become aware of our puppy parties?


Personal Recommendation: (whom may we thank?)


"In consideration of the acceptance of this registration, and the holding of classes, and the opportunity to have my dog participate, I agree to hold Pet Care Veterinary Clinic, Inc. harmless from any claim for the loss or injury. I personally assume all responsibility and liability for any such claim. By signing this form I am allowing Pet Care Veterinary Hospital to use class videos and photos for marketing materials, including the clinic website and social media pages."

Pet Care Veterinary Hospital



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*Please check required fields (Last Name,Firts Name, Full Address, Phone, Email) before submiting your form.

Pet Care Veterinary Hospital ©2017
5201 Virginia Beach Blvd. Virginia Beach, VA 23462
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