Zimzala Dog Hotel Registration

Dog Hotel Registration

New customer, please fill out the form below to register your dog(s) at Zimzala Dog Hotel.

Owner Information

Owner Full Names *

Owner Email Address *

Owner Contact Number *

Owner Address

Street Address *

City *

Postal Code *

Emergency Contact Information

Emergency Contact Full Names *

Emergency Contact Number *

Dog 1 Information

Dog 1 Name *

Dog 1 Breed *

Dog 1 Main Colours *

Dog 1 Weight (Optional)

Dog 1 Age *

Dog 1 Date of Birth (Optional)

Dog 1 Sex *

Male

Female

Dog 1 Neutered/Spayed? *

Yes

Dog 1 Microchip Number (Optional)

Dog 1 Behavioral Information / Special Needs (e.g., allergies, medications, anxiety)

Dog 1 Any medical conditions, injuries or allergies? (Optional)

Dog 1 Describe your dog/s food and feed patterns, any food allergies/sensitivities. (Optional)

Dog Vaccination History

"5-in-1" DHPPI Vaccination Date *

Kennel Cough Vaccination Date *

Rabies Vaccination Date *

Attach an image of Dog 1 Vaccination Card (Optional)

Veterinarian Information

Veterinarian or Practice Name *

Veterinarian or Practice Contact Number *

How did you hear about us? (Optional)

I agree to the Terms and Conditions *

Please review our terms before proceeding.