Additional Information on Your Pet

							                                                                                 For Staff Use:
                                                                                 Administrator ______________
                                                                                 Copy Spay/Neuter    _______
                                                                                 Copy DHLPP          _______
                                                                                 Copy Bordetella     _______

                                         Information on Your Pet
                                             (One form per pet please.)

Your Name: ______________________________                  Dog’s Name: __________________________________

Phone No #1: _____________________________                 Dog’s Age: ____    Breed: ________________________

Phone No. #2: _____________________________                Your e-mail Address: ____________________________

Emergency Contact Name: _________________________ Emergency Phone: ____________________________


Has your dog been in day care before? Yes___ No___
If yes when, for how long and reason for leaving? ___________________________________________________

Has your dog been socialized with other dogs? Yes___ No___

Has your dog been socialized with men and women? Yes___ No___

Is your dog aggressive with strangers? Yes___ No___

Is your dog aggressive on walks towards people? Yes___ No___

Is your dog aggressive on walks towards other animals? Yes___ No___

Is your dog spayed or neutered? (Please provide copy of Certificate from your Vet) Yes___ No___

Does your dog have any allergies? Yes___ No___
If yes please list them. _____________________________________________________

Is your dog on a flea treatment? Yes___ No___
If yes what kind. __________________________________________________________

Has your dog been in training classes and /or private? Yes___ No___
If yes by who, when and for how long. ________________________________________
_______________________________________________________________________

Attached a copy of the last invoice from your vet showing proof of vaccinations for: Rabies, DHLPP, Bordetella
(Bordetella is required every 6 months, available here for a $10 fee).

Please check what applies to your pet.
Problems        Dog aggressive__          People aggressive__       Jumps up__
                Chews__                   Digs__                    Barks__
                Runs away__               Unruly__                  Escapes__
                High jumper__             Shy__                     No obey__
                Toy possessive__          People possessive__       Separation anxiety__
                Stool eater__             Picky eater__             Housesoils__
                Other__

Is there anything else we need to know about your dog that will ensure safety? _____________________________

_________________________________________________________________________________________

How did you hear about us? __________________________________________________