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APPLICATION FORM

Daycare and Boarding Application

Owner(s)

Address City State Zip

Names of people authorized to drop off/ pick up your dog

Dog Information

Dog Name Breed

Date of Birth Color Weight

Male Neutered Female Spayed Markings

Veterinarian Address

Phone Fax

Medical Information

Immunization Requirements: It is the Owner's responsibility to provide proof of vaccination for each animal coming into THE DOG HOUSE. Dogs that are not up-to-date on their shots will not be allowed in. The following Vaccinations must be administered 5 days or more prior to attendance:

Date Given:  Distemper Rabies Bordetella (1 year)

OWNER UNDERSTANDS THAT EVEN IF YOUR DOG IS VACCINATED AGAINST CANINE COUGH (BORDETELLA), THERE IS STILL A CHANCE THAT YOUR DOG MAY CONTRACT CANINE COUGH. I AGREE THAT I WILL NOT HOLD THE DOG HOUSE RESPONSIBLE IF MY DOG CONTRACTS CANINE COUGH. (INITIAL)

Feeding Instructions

Name of food Quantity Frequency

Wet Dry Mix Dry mixed with water Allergies

Food restrictions Can He/She have treats? Yes No

Medication Frequency

General Questions

How did you hear about us?

How long have you had your dog?

Where did you get your dog?

Has your dog ever bitten anyone?  Yes No

Is your dog food or toy aggressive? Yes No

If yes, please explain

Has your dog ever been in a large play group before? Yes No

Has your dog ever been to daycare or boarding before? Yes No

If so, when was the last time?

What is your dog's favorite toy?

What is your dog's favorite treat?

Please list any information about your dog that we should know:

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