Registration Form

E-mail Address: *

Date *

Name *

Spouse/Significant Other

Address *

City *

State *

Zip Code *

Phone Number *

Spouse/Significant Other Phone Number

Alternate Phone Numbers

Emergency Contact Name (Must be local during pets stay with us) *

Phone Number *

Veterinarian Office *

Phone Number *

How did you hear about us? *

Pet Name *

Birthday *

Breed *

Weight *

Color/Markings *

Sex *

Female
Male

Spayed or Neutered? *

Yes
No

Flea Prevention Name *

Date last given? *

Heartworm Prevention Name? *

Date last given? *

What brand of food do you feed? You will provide the food for their stay. *

How much do you feed per meal? Food will need to be pre-portioned in ziplock bags per meal. *

How often do you feed you dog? *

Any additional items added to your dogs meal (wet food, water, etc) and how often?

Does your dog take medication? *

Yes
No

What is the name of the medication and what medical condition is it treating?

How often do you administer the medication?

What is the dosage?

How do you give the medication? Pill pocket, peanut butter, cheese, force pilling, etc.?

Does your dog take the medication easily?

Yes
No

Is your dog mouthy? Nipping or grabbing with mouth? If so, please explain. *

Is your dog crate trained? *

Yes, always does great
Yes, but its been a while since last in a crate
No, never been in a crate before
No, has anxiety in a crate

Is your dog potty trained? *

Yes, hardly ever has accidents
No but working on it
No, has accidents all the time or needs pee pads

Does your dog bark, growl or whine a lot? During play or warning? If so, please explain what causes it. *

Any past injuries or health conditions? If so, please explain. *

Does your dog dig? *

No
Yes, in the yard
Yes, under the fence

Has your dog ever jumped, climb or dug out of a fence? If so please explain. *

Is your dog afraid of loud noises or thunder? *

No
Yes, but only slightly affected
Yes, severe anxiety

Any aggression, either human or animal? If so, please explain *

Has your dog ever bitten anyone? *

Yes
No

Any issues taking food or toys away? If so, please explain. *

Does your dog have any issues sharing toys with other dogs? If so, please explain. *

Does your dog get along with other dogs? If not, what happened? *

Has your dog had any obedience training? What type? is it currently being used in your home? *

What commands does your dog know? *

Does your dog have any sensitive areas they do not like to be touched? *

How does your dog react to strangers and have they had any issues with specific types of people? *

How does your dog react to puppies or overly active dogs? *

Rate your dogs energy level on a scale of 1 - 10 *

1-3 (Low energy)
4-6 (Moderate energy)
7-9 (High energy)
10 (Overly Active)

Does your dog have any destructive behavior? Chewing up items, scratching floors/walls, ingesting foreign objects? *

Is your dog reactive on a leash? With people, dogs or both? *

No
Yes, with people
Yes, with dogs
Yes, with both

Any issues with anxiety? If so, please explain. *

Has your dog experienced off leash play at a daycare or dog park? *

No
Yes, Dog Park
Yes, Daycare

How often do they attend and when was the last time?

Has your dog ever experienced overnight care at a boarding facility before? *

Yes
No

How often did they board and when was their last stay? Any feedback given from previous experiences?

Are you applying for daycare or overnight care? *

Daycare
Overnight care

If daycare, when would you like to start?

If daycare, how many times per week would you like them to attend?

If overnight care, what is the requested date and time of drop off?

If overnight care, what is the requested date and time for pick up?

Attach Vaccines

Attach Heartworm and Flea Prevention

Attach Copy of Driver's License

Attach Additional Attachments

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