CAMP KITTY CLIENT REGISTRATION

Client Contact Information

Name:  ____________________________________________________________________________

Address:  __________________________________________________________________________

   __________________________________________________________________________

Email:  ____________________________________________________________________________

Home Phone: ______________  Work Phone:  ________________  Cell Phone:  _________________

Emergency Contact:  ________________________________Emergency Phone:  _________________

Cat Information

Name:  ______________________________________________  Age:  _____________

circle one:  Male/Female 

Spayed/Neutered?  (all cats over 6-months-old MUST be spayed/neutered)  ? Yes  ? No

FIV positive?  Yes  No

Does your cat have FeLV?  Yes No
 

Breed:  _____________________________  Color:  _________________________  Weight:  _______

Declawed?  ? Yes  ? No

Does your cat take any meds or have any medical conditions such as allergies?  ? Yes  ? No

If yes, please describe: _______________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

Veterinarian:  _____________________________________________  Phone:  __________________

Cat Information

Name:  ______________________________________________  Age:  _____________

circle one:  Male/Female 

Spayed/Neutered?  (all cats over 6-months-old MUST be spayed/neutered)  ? Yes  ? No

FIV positive?  Yes  No

Does your cat have FeLV?  Yes  No

Breed:  _____________________________  Color:  _________________________  Weight:  _______

Declawed?  ? Yes  ? No

Does your cat take any meds or have any medical conditions such as allergies?  ? Yes  ? No

If yes, please describe: _______________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

Veterinarian:  _____________________________________________  Phone:  __________________

Cat Information

Name:  ______________________________________________  Age:  _____________

circle one:  Male/Female 

Spayed/Neutered?  (all cats over 6-months-old MUST be spayed/neutered)  ? Yes  ? No

FIV positive?  Yes  No

Does your cat have FeLV?  Yes   No

Breed:  _____________________________  Color:  _________________________  Weight:  _______

Declawed?  ? Yes  ? No

Does your cat take any meds or have any medical conditions such as allergies?  ? Yes  ? No

If yes, please describe: _______________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

 __________________________________________________________________________________

Veterinarian:  _____________________________________________  Phone:  __________________