Home Boarding Questionnaire 1 1

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					                           Home Boarding Questionnaire

Dogs Name
Spayed or Castrated (Delete as appropriate)                                    Yes / No
If not spayed when is she due in season
Microchip (If yes please supply number if known)
Wormed                                                                         Yes / No
Date of last vaccination
Evidence of vaccinations provided
Date of last kennel cough vaccination
Flea medication (Please Supply date next due)

Is your dog registered under the dangerous dogs act 1991                       Yes / No
Is your dog licensed or classified under the dangerous wild animals act 1976   Yes / No
Registered vet name (please supply address and telephone number

Name and account number of insurers
Owners Name
Owners Address

Owners Telephone Number
Emergency contact name and number

Brand of food fed
How many meals a day, quantity and what are the normal feeding times

Any special food requirements
Is the dog allowed treats if so what types
Any allergies (If yes please specify)                                      Yes / No

Any medical conditions

Any medication to be given (if yes please give full details)

Is your dog fully housed trained                                           Yes / No
Usual times of walks and duration
Favourite games
Is your dog well socialised                                                Yes / No
How would you describe your dog’s character
Does your dog suffer from any behaviour problems or separation anxiety     Yes / No
If your dog happy to travel in the car                                     Yes / No
Has your dog ever bitten another dog, person or other animal               Yes / No

What things could scare your dog
Is your dog obedient on walks, will it give chase, not follow or run off
Any other useful command the dog will respond to

Please make any other comments that may be useful

Dates to be cared for
                           Home Boarding Consent form

Dogs Name
I hereby confirm I am the owners of the above named pet and from this         Owners Signature
date forward authorise Beth Bartlett to act as guardian during my
absence and take any action she considers suitable, in order to protect and
keep in good health whilst in her care.                                       Date
I do confirm that I will be responsible for any costs which might be
incurred, either veterinary or other, as a result of sickness, accident or
damage caused to or by the above named pet except third party liability
and I will pay for any such cost or expense on demand.
Beth Bartlett accepts no liability for the above.
Center Barks Dog Care requires a 50% deposit payable on booking a             Owners Signature
home boarding stay.
I understand this deposit is non-refundable and if the stay in cancelled at
short notice the full amount will be payable                                  Date

In the event of an accident/euthanasia do you wish to be notified whilst      Owners Signature
you are away (Delete as appropriate) Yes / No

Due to the nature of the home boarding environment, I understand that         Owners Signature
my dog may come into contact with other dogs whilst in the care of Beth
I do/do not give permission for my dog to be kept in the same room/area
as other/resident dogs (subject to familiarization) overnight and/or when
left alone
I do/do not give my consent for my dog to be exercised off the lead whilst    Owners Signature
in the care of Beth Bartlett

I do/do not give my permission for Beth Bartlett to use photos of my dog      Owners Signature
for her website

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