Owner's Information
Owner's Name
Co-Owner's Name
Home Phone     Cell Phone
Work Phone Best Daytime Phone
Email Address  
Street Address  
City     State      Zip

Please list names and phone numbers for other people authorized to pick your dog up from daycare:

Please let us know how you heard about us:
A Friend    Saw Sign   Google   Other Internet Search   Coupon
Vet Clinic (which one?)   
  Pet Store (which one?) 
Other (please specify)    

Dog's Information
If you are enrolling more than one dog, please fill this form out for each dog. 
Dog's Name        Birthday  Weight
Breed     Male  Female    Spayed/Neutered?
Where did you get your dog?
How old was your dog at the time?
Describe any prior experience your dog has had at a dog daycare:
Expected number of days per week or month your dog will attend:

Reason for enrolling your dog in daycare: (please select all that apply)
Exercise          Fun          Cannot be left alone          SocializationHousetraining issues at home
Other (please specify)

Health Information
Veterinarian Name and Clinic
Vet Phone   Vet Address
Please list any known food allergies  
Brand of Food

Does your dog ever cough due to tracheal damage, allergies, pressure from collar on throat, or any other reason?  If yes, please describe. 

Please describe any injuries or ongoing health issues, and list any medication needed for behavioral or medical issues:

Training
Location & date of prior training classes
Any training challenges?

Any training equipment used on walks?

Personality
How often does your dog play with other dogs?
Types/breeds of dogs your dog does not like   Any kinds of people your dog automatically doesn’t like?
Has your dog ever growled at a person? Please describe:
 Has your dog ever bitten a person? Please describe:
Has your dog ever bitten a dog? Please describe:

Please select the words that describe your dog:
Alert                 Goofy           Sweet          Jealous
Predatory         Happy          Immature     Aggressive
Pushy             Active           Hyper           Possessive
 Protective       Shy               Mellow          Well-behaved
Demanding     Fearful         High Energy High Strung 
Unruly              Playful         Dominant    Submissive 
Wonderful       Anxious         Stubborn      Territorial 
      `

Play style with other dogs:
Has many dog friends   Likes off leash parks   Nippy
Loves to wrestle            Hates being mounted Barky
Loves to chase              Loves to be chased    Mouthy
 Scares small dogs        Herds other dogs        Guards toys 
Frequently mounts         Afraid of big dogs        Fetch Dog
Gentle with small dogs  Gets mounted frequently  
Likes people better than dogs     

Please select any of the behaviors that might sometimes apply to your dog:
Afraid of vacuums    Does not obey        Mouthy/bites people 
Can't grab collar       Separation anxiety  Chews excessively
Toy-possessive        People-aggressive Barks excessively
Eats non-food itemsEscape artist          Destroys Toys
Noise phobias           Kills small critters  Jumps Fences
Growls at strangers  Jumps on people   Guards food
Pees/poops in houseCan't be brushed   Food thief    
Eats Poop                 Attacks dogs when on leash
Guards house or yard       

Please add anything else we should know about your dog: