Dog Daycare Intake Form

Dog Daycare Intake Form
Please complete this form so we can safely and appropriately care for your dog at daycare.
Owner and Dog Information
Owner Full Name
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Dog Name
Breed
Age or Date of Birth
Sex
Other
Weight (lbs)
Health, Behavior, and Care Needs
Current vaccination status
Other
Proof of current vaccinations provided
Other
Flea and tick prevention status
Other
Medical conditions, allergies, or medications
Other
Temperament and behavior around others
Rows Calm/Comfortable Cautious/Needs Space Reactive/Concern
Other dogs
Adult people
Children
New environments
Leash walking
Separation anxiety
Feeding instructions and care notes
Behavior concerns or bite history
Other
Emergency, Scheduling, and Daycare Preferences
Emergency Contact Name
First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup Person
First NameLast Name
Veterinarian Contact Name
First NameLast Name
Veterinarian Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Requested Daycare Start Date
MonthDayYear
Date
Preferred Attendance Schedule
Other
Special Instructions for Drop-off/Pickup
Should be Empty:

Select theme: