Doggy Play Camp

Guest Enrollment Form

Client Information

Dog’s Name:

Parent’s Name:

Street Address:

City, State, Zip Code:

Home Phone Number:

Cell Phone Number:

Work Phone Number:

E-Mail Address:                                   (by supplying this, you agree to receive periodic email from DPC)

Other people authorized to pick up your pet:

Veterinarian Information

Vet Clinic:

Street Address:

City, State, Zip Code:

Phone Number:

Emergency Contact (Other than self or Veterinarian)

Name:

Street Address:

City, State, Zip Code:

Home Phone Number:

Cell Phone Number:

Work Phone Number:

Pet Information

Breed:

Birth date:

Male / Female                                            Neutered / Spayed

Food:  Canned / Dry                                 Brand:

Amount Per Day:                                      Allowed to have biscuits? 

Approximate Weight:                    

Microchip:  Yes / No                                   Number:

Color(s)/Markings:

Rabies due:                                     DHLPP due:

Bordatella/Kennel Cough due: (Required every 6 months)

Yearly Heartworm Test?     Yes / No

          If yes, what brand of preventative?

Flea and Tick Medication?   Yes / No

          If yes, what brand and preventative?

v     All dogs must be on a flea control program to attend day care.

v     If fleas are present on a dog, a single 8 hour pill that kills adult fleas will be administered and the owner will be charged $10.00 on current bill.

v     Doggy Play Camp will monitor dogs for fleas and ticks as best as possible; however, we are not liable for additional costs that may occur regarding flea/ticks, flea/tick treatments for you pet, and/or home or yard treatments for your home.

Is you dog taking any other medications (if yes, please list)?

Is your dog allergic to any medication (if yes, please list)?

Does your dog have anything contagious?

Does your dog have any old or current injuries or health concerns?

Food

How often is your pet fed meals each day?

How long is the food bowl left down with food in it?

Is your pet fed treats each day?          If yes, how many?

What is your pets favorite treat?

Will you be bringing your dog’s food to Doggy Play Camp?
 

Social

Has your dog been socialized with other dogs?

Does your dog go to dog parks?

During walks is you dog aggressive towards other animals?

Has your dog ever been attacked or injured by another dog?

Has your dog ever bitten another dog?     If yes, under what circumstances?

Does your dog dislike any breeds, types, or genders of dogs?

Has your dog been socialized with men and women?

Is your dog aggressive with strangers in your home?

During walks is your dog aggressive towards people?

Family LIfe

How long has your dog been in your family?

Is your dog house trained?

Is your dog comfortable with having his/her collar used as a lead?

How many hours a day is your pet alone?

What obedience, tricks, or commands does your dog know?

Describe your dog’s activity level:   Low   Medium   High

Describe your dog’s demeanor when riding in a car?

                   Enjoys      Likes      Dislikes

Does your dog get sick when riding in the car?

Does your dog normally ride in a restraint in the car?

Where does you pet stay during the day:

Crated    Loose in the House    Particular Section of the House   Fenced Yard   Tie-Out

Where does you pet stay during the night.

Crated    Loose in the House    Particular Section of the House   Fenced Yard   Tie-Out

How often is your pet let out of the house or taken on walks for elimination purposes?

Has your dog ever growled or snapped at anyone who's touched his/her chew bones, food, or toys?

If your dog has something in his/her mouth that you did not want him/her to have, would he/she drop the object if asked?

Would he/she let you take if from him/her?

Is your dog sensitive about being touched on certain areas of his/her body? (I.e. feet, tail, ears, paws, chest, neck, etc.)

To ensure the best possible experience for your dog, please indicate any issues we need to be aware of:

_____Jumps on people                     _____Chews paws, etc        _____Digs

_____ Escapes                                  _____Runs away                  _____Unruly

_____High jumper/Fence climber     _____Shy                             _____Barks

_____Separation Anxiety                  _____Stool eater                  _____Picky eater

_____Destroys toys                           _____Strong leash puller

_____Other:________________________________________________________________________________

As Owner of the above said pet,

I hereby give consent for emergency medical care as prescribed by a duly licensed veterinarian.  This care may be given under whatever conditions are necessary to preserve life, limb, or the well being of my pet.

Owner expressly acknowledges and agrees that the Owner shall be responsible for all costs and expenses incurred under such veterinarian service.  Prior to delivering the pet to the veterinarian, Doggy Play Camp will first attempt to contact Owner via telephone.

I hereby give Doggy Play Camp permission to take photos of my pet for identification purposes.

_________________________________________________   ________________________

Signature                                                                 Date