Mississippi Canine Services |

Information Form & Agreement

First Name *

Last Name *

Phone *

Email Address *

Address *

What is your dog's name, age & breed or breed-type *

Please list all dogs that will be boarded:

Please name the veterinarian office you use & the name of the veterinarian you prefer *

Please indicate any special info I need to know about your dog. Medications, allergies, etc.

Is your dog current on flea prevention? *

Please upload current vaccination records

Maximum file size: 10 MB

I understand that MS Canine Services takes every precaution to keep my dog healthy & safe while in their care; however, I am responsible for all veterinary bills for my dog in the extremely rare circumstance where needed. *

Type your first & last name to serve as an electronic signature.