DOG PROFILE FORM. First Name: Last Name: Address: Home Phone: Work Phone: Cell Phone: Name: Relationship: Phone Number:
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1 Prairie Pawz LLC 2448 Brooks Dr. Sun Prairie, WI T DOG PROFILE FORM CLIENT INFORMATION: First Name: Last Name: Address: City: State: Zip: Home Phone: Work Phone: Cell Phone: Emergency Contact: Name: Relationship: Phone Number: Please list those whom are authorized to pick up your dog: 1.) Name: Relationship: 2.) Name: Relationship: Veterinarian: Clinic Name: Address: Telephone Number:
2 PET GUEST INFORMATION Name of Dog: Breed or Mix (Primary Two): Weight: Color: Age/Birthday: Check where appropriate: O Male O Female O Spayed O Neutered O Unaltered Has your dog ever attended a daycare or boarding facility in the past? O No O Yes Has your dog ever been to a dog park? O No O Yes Does your dog have a basic understanding of commands (sit, stay, down, etc.)? O No O Yes Any other commands that would be helpful? Does your dog know any tricks? O No O Yes Is your dog housebroken? O No O Yes O Paper/Pad Trained Is your dog crate trained? O No O Yes Type of dog food, amount, and feeding instructions: Is your dog allowed to have treats? O No O Yes
3 MEDICAL HISTORY Is your dog currently taking any medications? O No O Yes NOTE: IF YOU CHECKED YES, YOU WILL NEED TO FILL OUT AND SIGN A MEDICATION ADMINISTRATION FORM FOR EACH PET Has your dog been ill in the last 30 days? O No O Yes Does your dog have any physical disabilities? O No O Yes Is your dog displaying any symptoms such as coughing, sneezing, or upset stomach? O No O Yes Does your dog have any previous or current injuries, physical problems or health concerns, including allergies? O No O Yes If yes, please explain: Does your dog have any physical restrictions while playing, or sensitive areas on the body? O No O Yes If yes, please explain: Is your dog microchipped? O No O Yes VACCINATION RECORDS Please list the administration dates for the following vaccinations: Bordetella vaccination must be administered at least 7 days prior to any services at Prairie Pawz; 3 days for a nasal vaccination. Please provide proof of vaccinations from your vet. Staff will verify once we have received proof of current vaccinations. Rabies DHPP (distemper, hepatitis, and parvovirus/parainfluenza) Bordetella (Kennel cough) H3N2 (Flu) Lepto Is your dog currently on a flea preventative medication? (Required for all guests) O No O Yes Name of brand: Date of last treatment: / / If Prairie Pawz LLC, finds evidence of ticks or fleas, treatment will be provided at owner's expense. Is your dog being treated for heartworm? (Required for all guests) O No O Yes Name of brand: Date of last treatment: / / Date of last fecal exam (Must have a negative exam every six months)
4 PERSONALITY Please check all answers that describes your dog's personality: O Outgoing O Timid O Affectionate O Reserved O Protective O Feisty O Friendly O Obedient O Aggressive O Independent O Playful O Confident O Submissive O Clingy O Gentle Please check all answers that describe your dog's attributes: O Jumper O Biter O Digger O Climbs Fences O Fears Noises O Howls O Active Chewer O Barks Excessively O Likes to Herd O Low Activity Level O Medium Activity Level O High Activity Level O Toy Aggressive O Food/Treat Aggressive O Separation Anxiety O Excessive Marking O Excessive Mounting O Coprophagia (Eats Feces) O Other: Has your dog ever bitten a person or another dog? O No O Yes If yes, please explain: Has your dog ever escaped? O No O Yes If yes, please explain: Please check all that apply when describing situations where your dog may become unfriendly: O Grabbing collar O Being removed from furniture O Meeting strangers O Meeting other Dogs O Being hugged O Being brushed O Being touched while sleeping O Being touched on the ears O Being touched on the paws O Being touched on the mouth O Being touched on the tail O Being touched on the lower back O Around women O Around men O Around children Other: O
5 Has your dog ever displayed any of the following behaviors? (Please check all that apply and explain the situations): O Will bite O May bite O Growls O Snaps O Shows Teeth O Trembles O Freezes O Moves Away Is your dog afraid/nervous of anything (thunderstorms or fireworks)? O No O Yes If so, what may help to relax your dog? Your dog plays best with: O No Dogs O Big Dogs O Little Dogs O Older Dogs O Puppies Off -Leash Play Information: Has your dog had any issues in an off-leash social environment? O No O Yes If yes, check all that apply and explain below: O Altercation or fight at a public park O Altercation or fight with a friend s/neighbor s dog O Fearful reaction in a group of dogs O Dismissed from a prior dog daycare or social playgroup program O Other: Does your dog like to play any games (fetch or tug of war) O No O Yes Does your dog like to play in water O No O Yes On-Leash Behavior: Does your dog have any of the following issues when walking on a leash? O Pulling O Biting the Leash O Stopping Abruptly O Other Does your dog require any special harness/collars? O No O Yes Does your dog require any special commands/needs? O No O Yes
6 Shampoo Selection: Prairie Pawz LLC administers free departure baths for guests boarding for 7+ nights. Prairie Pawz LLC proudly offers shampoos designed to safely clean our guests. Please select a shampoo that we may use on your dog during a bath. *You may change this selection at any time by speaking to our front desk: O Oatmeal Shampoo & Conditioner O Hypoallergenic O Coat Brightener O Tearless Shampoo I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner or representative of the dog subject to this application that my signature is sufficient to enter into this application for and on behalf of any other owner or representative. Signature of Owner (s) Date REV. 11/06/2018
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J.M. PET RESORT REGISTRATION FORM J.M. PET VET CLINIC / DAYCARE / BOARDING / TRAINING / GROOMING FOR DOGS ONLY Where your pet is a part of our family Thank you for joining the the J.M. Pet Resort family!
Aunt Lyn s Doggie Care
Fee Schedule Services: All services must be prepaid. Monthly Passes must be used in the month of purchase. Members lock in the same price for vacation and extra days PREPAID MONTHLY DAYCARE MEMBERSHIPS
J.M. PET RESORT REGISTRATION FORM
J.M. PET RESORT REGISTRATION FORM Where your pet is a part of our family J.M. PET VET CLINIC / PLAYtrain DAYCARE / BOARDING / TRAINING / GROOMING Date Name of owner: Co-owner: E-mail (1): E-mail (2): Address:
Dear Prospective Volunteer,
Dear Prospective Volunteer, Thank you for your interest in the Pet Pals pet therapy program. This program screens teams of volunteer dogs and their owners for visiting patients at the American Family Children
PLEASE KEEP THIS PAGE FOR YOUR RECORDS
General Information about All Pets Dog Daycare DOGS ALL dogs must pass a temperament test prior to their first day of daycare. Temperament tests generally last 1 hour and an appointment is REQUIRED for
AGREEMENT & WAIVER FORM
AGREEMENT & WAIVER FORM By signing this document I, as the owner/agent/guardian, guarantee that I will be personally liable for all expenses resulting from daycare, boarding, bathing and grooming, veterinarian
DOGTOPIA DOG ENROLLMENT FORM
DOGTOPIA DOG ENROLLMENT FORM We are thrilled your dog will be joining the fun here at Dogtopia! Please fill out the forms below, save and email to your preferred location. You can find each Dogtopia location's