STC Reservation Request YOU MUST BE A CURRENT CLIENTWe are not accepting new clients at this time.SHORT TERM CLOSED DATES 2019September 13th - September 27th November 1st - November 8thSHORT TERM CLOSED DATES 2020January 6th - January 17th April 17th - April 27th September 11th to September 25th November 6th to November 13th Your name First Last Email* Name of dog(s)*DATE OF DROP OFF* Date Format: MM slash DD slash YYYY TIME OF DROP OFF* NOON - 1 PM 7 PM - 8 PM DATE OF PICK UP* Date Format: MM slash DD slash YYYY TIME OF PICK UP* NOON - 1 PM 7 PM - 8 PM Emergency contact person during this trip* First Last This is a person who would be available to pick up your dog if there is a medical emergency and take to the Vet.Cell phone number of Emergency contact person.*FEEDING INSTRUCTIONS (please enter quantities)*MEDICATION INSTRUCTIONSSPECIAL LIMITATIONS* Cannot do stairs Advanced age Separation anxiety Incontinent None Comments for this stayPLEASE NOTE: House with a Heart reserves the right to turn away any dog that is in poor condition at the time of drop off. This includes: Dogs who are in obvious pain, have not been seen by a Vet and do not have medication to keep them comfortable. Dogs who are matted and dirty and in need of grooming.* I agree I disagree If necessary: Do we have permission to bathe your dog* Yes No This iframe contains the logic required to handle Ajax powered Gravity Forms.