Boarding Dates Requested Begin

Boarding Dates Requested End

Daycare Dates Requested Begin

Daycare Dates Requested End

Your Name  *

Your Email  *

Mailing Address 1

Mailing Address 2

City

State or Province

Zip or Postal Code

Home Phone

Work Phone

Alternate Work Phone

Cell Phone

Alternate Cell Phone

Weekday Daytime Emergency Contact Phone

Weekday Evening Emergency Contact Phone

Weekend Daytime Emergency Contact Phone

Weekend Evening Emergency Contact Phone

How Did You Hear About Us?

If Search, what were Search Criteria (what you typed in to find us)?

Did a person recommend us? If so,whom?

Did a Veterinarian Recommended Us? If so, whom?

Breed

Dog's Name  *

Approx. Date of Birth

Sex  Male   Female 

Approx. Weight

Spayed or Neutered?  Yes   No 

If Yes, Age When Spayed Neutered?

Age When Acquired?

Where Did You Get Your Dog?

Has Your Dog Ever Been To A Daycare Boarding Facility Before?  Yes   No 

If So, Did The Facility Have? Individual runs with no playtime with other dogs  Individual runs with some playtime with other dogs  All day playtime with other dogs 

Was Your Dog Comfortable At The Daycare Boarding Facility?  Yes   No 

Were You Happy With The Care They Provided?  Yes   No 

If not, please explain:

Does Your Dog Like To Play With? Neutered Males  Spayed Females  Intact Males  Intact Females  Any/All 

To What Types Of Social Interaction Has Your Dog Been Exposed? Dog Parks   Other Daycare Facilities  Dog Classes  Dog-Friendly Trails or Areas   Neighborhood Dogs   Play Dates with Friendʼs Dogs 

Is Your Dog Possessive Of Any Toys Food Or Objects?  Yes   No 

If yes, please explain:

Has Your Dog Ever Growled Or Snapped At Anyone Taking Food Or Toys Away?  Yes   No 

If yes, please explain:

Has Your Dog Ever Shared His Her Food Toys Or Bedding With Others?  Yes   No 

What Types Of Toy sAre Your Dogs Favorite?

How Would You Describe Your Dog's Personality? Would you say your dog is more?  Dominant   Submissive 

What Behaviors Have You Seen That May Exhibit This?

Are There Any Specific Dogs To Which Your Dog Reacts Negatively? Neutered Males  Spayed Females  Intact Males  Intact Females  Smaller Dogs  Larger Dogs  Hyper Dogs   Puppies  Specific Breed 

If specific breed, please explain:

Has Your Dog Ever Bitten Another Dog?  Yes   No 

If yes, please explain:

Has Your Dog Ever Bitten A Person?  Yes   No 

If yes, what were the circumstances under which that occurred?

How Does Your Dog React When Approached By Strangers At Home Or Yard Or Out In Public?

How Does Your Dog Respond To Other Dogs While On Leashed Walk? Neutered Males  Spayed Females  Intact Males  Intact Females  Smaller Dogs  Larger Dogs  Hyper Dogs   Puppies  Specific Breed 

If specific breed, please explain:

Name of Training Facitlity

Trainer Name

What Is Your Dogs Training History? No Training   Trained Yourself   Puppy Kindergarten  Basic Obedience   Intermediate Obedience   Advanced Obedience  Basic Agility  Advance Agility  Private Sessions - Work Specifically On 

If private session, please explain

Does Your Dog Have Any Allergies?  Yes   No 

If so, please list:

Are There Any Kinds Of Food Or Treats That Your Dog Cannot Have?  Yes   No 

If yes, please list:

What Kind Of Food Do You Feed Your Dog?

How Much Exercise Would You Say Your Dog Is Getting?

Does Your Dog Have Any Medical Problems Or Take Any Medications?  Yes   No 

If so, please explain:

Does Your Dog Have Any Physical Problems Or Disabilities Which May Affect Them When Playing With Other Dogs?  Yes   No 

If so, please explain:

Does Your Dog Need To Be Periodically Rested During The Day While At Our Facility?  Yes   No 

If so, please explain:

Does Your Dog Have Any Kind Of Phobias/Fears?  Yes   No 

If so, please explain:

Does Your Dog Exhibit Any Problem Barking Behaviors?  Yes   No 

If so, what has been effective in quieting them down?

While At Home Does Your Dog Follow You From Room To Room?  Yes   No   Sometimes