Daycare Application
Location (*)
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DOGGIE INFORMATION
Dog's Name (*)
Please let us know your name.
Breed or Mix (*)
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Coat Colour (*)
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Age / DOB (*)
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Sex (*)
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Spayed/Neutered (*)
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Micro-chipped/Tattoo
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CLIENT INFORMATION
First Name (*)
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Last Name (*)
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Address (*)
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Phone # (*)
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Alternate #
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Email Address
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Special Instructions for Contacts
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WHO IS AUTHORIZED TO PICK UP YOUR DOG?
Name 1 (*)
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Name 2
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VETERINARIAN INFORMATION
Name of Clinic (*)
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Veterinarian's Name
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Address
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Vontact Number
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Shot Record (date administered)
DHLLP
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BORDETELLA
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RABIES
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Flea/Tick Control



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(Check brand name of product used. Dogs must be protected seasonally in order to participate at Doggie Central Ltd.)
Is your dog on any type of medication? (*)
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If yes please describe
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Does your dog have any sensitive areas on his/her body? (*)
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If yes please describe
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What brand of food are you feeding your dog?
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IMPORTANT: Please bring written documentation of all of your dog’s vaccinations and flea prevention program to the assessment review. Please note that many veterinarians administer the Bordatella vaccination only by request
DOGGIE PROFILE
How long have you had your dog?
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Where did you get your dog?


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If adopted, do you have knowledge of your dog’s past history?
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SOCIAL BEHAVIOUR
Does your dog respond to the following commands? (please check all applicable) (*)
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Please list any other commands your dog responds to.
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When introduced to a new dog, is your dog; (please check all applicable) (*)
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Has your dog ever bitten another dog? (*)
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If yes please explain the circumstances.
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Has your dog ever bitten a person? (*)
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If yes please explain the circumstances.
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Has you dog shown aggression towards any of the following;
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LIFESTYLE
Number of adults in your household (*)
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Number of children in your household
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Please indicate how many and the type of other animals in your household
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Is your dog house trained? (*)
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Is your dog crate trained? (*)
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Does your dog walk off leash (*)
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Does your dog have free run in your home? (*)
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Is your dog allowed on furniture? (*)
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Where does your dog typically sleep? (*)
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OTHER INFORMATION
Is there anything else we should know about your dog?
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Contract, Release and Agreement (*)
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Today's Date (*)
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I Agree (*)
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