Owner's Name:  _________________________________________
    Dog's Name: __________________  D.O.B.          /             /
    Breed: ___________________________________
 
 
 

    1. Rabies vaccination given ____________________ Due:___________ or
        too young _________ (puppies that are too young for Rabies vaccination may start
            kindergarten and then their rabies vaccination during the class.)
 

    2.  Negative Fecal test on ________________ - Mandatory test.
        (test must have been completed within the last 6 months)

    3. D.H.L.P. Parvo Vaccination given on ___/____/___  Due: ___/____/___
        - Mandatory.

    4. Bordetella (kennel cough) given ___/____/___  Due: ___/____/___
        (recommended but not mandatory)
 

    _____________________________ Signature of Veterinarian
                                                                    or Clinic Stamp
 
 
 

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