"Dog Daycare Application Template - Okagan K9"

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Download "Dog Daycare Application Template - Okagan K9"

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DOG DAYCARE APPLICATION FORM
CLIENT INFO:
Name:
Home Address:
Local Address (Visitor/Tourist):
Work Phone:
Cell:
Home Phone:
Email Address:
ALTERNATE CONTACT
(Incase we cannot get in touch with you using the above info)
Name:
Address:
Work Phone:
Cell:
Home Phone:
PET INFO:
Name:
Sex: M / F
Name:
Sex: M / F
Spayed/Neutered? Y / N
Spayed/Neutered? Y / N
Age:
Weight:
Age:
Weight:
Breed:
Breed:
Colour:
Colour:
ID Type/# (tatoo, chip etc…)
ID Type/# (tatoo, chip etc…)
VET INFO:
Phone #:
Clinic:
Vets' Name:
MEDICAL:
Vaccinations
(* Proof required *
- Please put an "x" by each vaccination your dog is up-to-date on)
Distemper
Parvovirus
Rabies
Bordatella
Is your dog spayed/neutered?
Y ___
N ___
Does your dog have any health concerns that we need to be made aware of?
Y / N
If yes, describe:
Does your dog have any medical restrictions on his/her activities? Y / N
If yes, describe:
Is your dog currently on any medication? Y / N
If yes, describe:
Does your dog have any allergies?
Y / N
If yes, describe:
Does your dog receive a flea/tick preventative? Y / N Brand ______________ Frequency: _______
DOG DAYCARE APPLICATION FORM
CLIENT INFO:
Name:
Home Address:
Local Address (Visitor/Tourist):
Work Phone:
Cell:
Home Phone:
Email Address:
ALTERNATE CONTACT
(Incase we cannot get in touch with you using the above info)
Name:
Address:
Work Phone:
Cell:
Home Phone:
PET INFO:
Name:
Sex: M / F
Name:
Sex: M / F
Spayed/Neutered? Y / N
Spayed/Neutered? Y / N
Age:
Weight:
Age:
Weight:
Breed:
Breed:
Colour:
Colour:
ID Type/# (tatoo, chip etc…)
ID Type/# (tatoo, chip etc…)
VET INFO:
Phone #:
Clinic:
Vets' Name:
MEDICAL:
Vaccinations
(* Proof required *
- Please put an "x" by each vaccination your dog is up-to-date on)
Distemper
Parvovirus
Rabies
Bordatella
Is your dog spayed/neutered?
Y ___
N ___
Does your dog have any health concerns that we need to be made aware of?
Y / N
If yes, describe:
Does your dog have any medical restrictions on his/her activities? Y / N
If yes, describe:
Is your dog currently on any medication? Y / N
If yes, describe:
Does your dog have any allergies?
Y / N
If yes, describe:
Does your dog receive a flea/tick preventative? Y / N Brand ______________ Frequency: _______
HISTORY:
Where did you get this dog?
How long have you had him/her?
If you have not had him/her from puppyhood, what do you know of his/her prior history?
Describe:
**
**
If feeding of a meal is requested, food must be provided by client
FEEDING & TREATS:
Is your dog allowed to have treats? Y / N
Any treats to avoid?
Brand of food & Type (dry/wet) you feed your dog:
If applicale, what time would you like us to feed your dog?
Quantity:
HOME ENVIRONMENT:
Are there any other animals in the household?
Y / N
If yes, what kind:
Dog ______
Cat ______
Other (Please specify)
What is the make up of your household?
Place an "x" where applicable
Adult Males:
Adult Females:
Children:
Ages of Children (if applicable):
Which family member does your dog relate to the best?
What do you do with him/her when you leave the home?
BEHAVIOUR & SOCIAL SKILLS:
Does your dog have any known behavioral problems? Y / N
If yes, describe:
Does your dog suffer from any degree of separation anxiety? None ____ Mild ____ Extreme
Is your dog housebroken?
Y / N
Best word to describe your dogs overall temperament :
Does your dog have any areas on his/her body that he/she does not like to be touched? Y / N
If yes, where? _____________________________
How does your dog usually react to other dogs they meet?
Has your dog ever attended Doggie Daycare?
Y / N
If yes, how did he/she get along with the other dogs?
Has your dog ever participated in play at a dog park?
Y / N
If yes, how did he/she get along with the other dogs?
Has your dog ever been aggressive towards another dog?
Y/N
If yes, describe circumstance:
How does your dog react to strangers?
Does your dog have any kind of people he/she automatically fears or dislikes?
Y / N
If yes, describe:
Does your dog have any breed/energy/size of dog that they automatically fear/dislikes?
Y / N
If yes, describe:
Has your dog ever bitten a person, another dog or been in a dog fight?
Y / N
If yes, describe:
Has your dog ever attempted to escape by digging/jumping/squeezing thru/climbing fences?
Y / N
Does your dog jump on people? Y / N If yes, how do you stop him/her?
What is your dogs favorite toy? ________________ Is he/she possessive over his/her toys? Y / N
Has your dog shared toys/food/water with other dogs before?
Y / N
Any Problems?
Y / N
Does your dog have a circumstance or situation that he/she is frightened of?
Y / N
If yes, describe:
Describe how you would calm the dog during this situation:
Is there anything specific you feel we should know about your dog?
Y / N
If yes, describe:
EXERCISE:
Do you walk your dog? Y / N
If yes, how often? ____________
Distance? ____________
What other exercise does your dog receive?
How often?
TRAINING:
Has your dog ever received any formal training? Y / N
Does your dog know any basic commands?
Y / N
If yes, describe:
What special/fun commands does your dog know?
What is his/her "potty" command:
What does your dog respond most to? (food/play/special toy etc…)
** Please note that Okanagan K9 reserves the right to refuse enrollment to any dog at any
time and for any reason.
I certify that, to the best of my knowledge, the information I have provided above is true.
Signature:
Date:
Print Name:
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