Owners Name:…………………………………….……Tel No:.................................................

Owners Address:………………………….....................Mobile:……………………………….

…………………………………………………………Email:………………………………...

…………………………………………………………Date of Stay………………………….

Number of Cats:……………………………………….Date of Departure:……………………

Name of Cat(s):…………………………………………………………………………………

Name & Address of Contact to act on your behalf:………………….………………………….

………………………………………………………………………………………………..

*I have informed my contact about my cat's requirements whilst I am away – YES/NO

Country being visited:…………………………………………………………………………...

Contact Address and Telephone (if available)…………………………………………………..

…………………………………………………………………………………………………..

Health Status:

Please bring your Vaccination Record Card with you. This will inform us of the Date, Brand and Batch No. for the most recent Vaccination or Booster. Your cat will not be able to be admitted without this.

Name of Veterinary Practice:…..………………………………………………………………..

Telephone Number:……………………………………………………………………………...

* I have informed my Vet that my cat is staying in the cattery – YES/NO

Identification Number (Microchip etc):………………………………………………………...

Flea and Worm Treatment (Type and Date when last administered)………………………….

Please give details of any current or recent medical treatment/illness, which may be relevant. Name or type of medication, dosage amounts and regularity, availability of further supply if necessary:

Treatment/Illness:……………………………………………………………………………….

Medication:……………………………………………………………………………………...

Dosage Rate (How much and how may times a day?)………………………………………….

Feeding and other Requirements:

Please state clearly exact details of any special veterinary food and amounts to be given:

…………………………………………………………………………………………...............

…………………………………………………………………………………………………...

Is grooming enjoyable to your cat – YES/NO

Please bring in your cat's favourite toy if wished.

If you wish to bring your own bedding, you are most welcome – YES/NO

Any other information we should be aware of please use back of sheet.

SIGNATURE:………………………………………………………DATE:………………….