Ko-Z II Pet Application
Pine & Cherry Streets, Gloversville, NY
518-774-4181
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Email *
Name
Lot #
Veterinarian Name
Veterinarian Phone
1. Pet's Name
Pet's Age
Pet's Color/Markings
Dog Breed
Cat Breed
Indoor/Outdoor (cats)
Clear selection
Other Pet Type (reptile, bird, fish)
License Number (if applicable)
Adult Weight
Male/Female
Clear selection
Date Fixed
Date Vaccinated
Type of Flea and Tick Prevention (serresto, revolution, frontline, etc)
2. Pet's Name
Pet's Age
Pet's Color/Markings
Dog Breed
Cat Breed
Indoor/Outdoor (cats)
Clear selection
Other Pet Type (reptile, bird, fish)
License Number (if applicable)
Adult Weight
Male/Female
Clear selection
Date Fixed
Date Vaccinated
Type of Flea and Tick Prevention (serresto, revolution, frontline, etc)
3. Pet's Name
Pet's Age
Pet's Color/Markings
Dog Breed
Cat Breed
Indoor/Outdoor (cats)
Clear selection
Other Pet Type (reptile, bird, fish)
License Number (if applicable)
Adult Weight
Male/Female
Clear selection
Date Fixed
Date Vaccinated
Type of Flea and Tick Prevention (serresto, revolution, frontline, etc)
By signing my name below, I agree to abide by Ko-Z II Rules and Regulations concerning pets. I understand that I will be held responsible if either myself, my residents, or my guests do not adhere to the rules and that permission to keep my pets may be revoked at anytime.
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