Pet Registration

Today's Date *
Today's Date
Name *
Name
Name
Name
Home Phone Number
Home Phone Number
Cell Phone Number
Cell Phone Number
Work Phone Number
Work Phone Number
Pet Information
Register up to four dogs.
Dog Number 1 Information
Vaccinations Current? *
Please e-mail (reihartg@aol.com), fax (717) 4320027 or deliver hard copy of veterinarian's vaccination for rabies on first visit to the Spa.
Date of Rabies Shot *
Date of Rabies Shot
Reason for Swim
Dog Number 2 Information
Vaccinations Current?
Date of Rabies Shot
Date of Rabies Shot
Reason for Swim
Dog Number 3 Information
Vaccinations Current?
Date of Rabies Shot
Date of Rabies Shot
Reason for Swim
Dog Number 4 Information
Vaccinations Current?
Date of Rabies Shot
Date of Rabies Shot
Reason for Swim
Veterinarian Information
Veterinarian's Phone Number
Veterinarian's Phone Number
Information Verification
Verification and Acceptance *
I/we the undersigned owners of the above dog or dogs hereby accept full responsibility for our/my animal's health and safety while swimming or visiting this facility. I/we agree to hold safe and harmless Gary D. Reihart, Beverly J. Reihart, their agents and/or assigns from any liability caused by injury while on this property. Further, I/we grant the same relief from liability and responsibility ourselves, our children, relatives or friends we have invited to the facility. I/we certify that our dog or dogs have been properly vaccinated and are not a carrier of any disease or illness. I/we agree to keep our dogs under total control at all times and take full responsibility for any dog or individual that my/our dogs may bit or harm in any way.*

Please e-mail (reihartg@aol.com), fax (717) 4320027 or deliver hard copy of veterinarian's vaccination for rabies on first visit to the Spa.