CLIENT INFORMATION

Owner Information

Your name

Your full address

Home phone number

Mobile phone number

Your email

Emergency Contact

Name

Mobile phone number

Home phone number

Registered Veterinary Clinic

Name

Phone number

Address

Insurance Details

Insurance Company

Phone number

PET INFORMATION

Dog's Name

Dog Breed

Sex
MaleFemale

Dog's Date of Birth

Spayed / Neutered
YesNo

Colour

Tagged & Microchip Number

Medical & Behavioural History (e.g. treatments administered against parasites and restrictions on exercise)

Allergies or Food Restrictions

Wormed (dates will be required for each dog's most recent worming treatment)
YesNo

Vaccinated (dates will be required for each dog's most recent vaccination. Vaccination card to be seen. Or to be Titre tested with an up to date veterinary certificate)
YesNo

Flea Treatment (dates will be required for each dog's most recent flea treatment)
YesNo

Dietary Requirements (including any allergies that we should be aware of)

Feeding Regime (e.g. how many times a day is your dog fed and at what times? How much food at each feed?)

Are there any other dogs boarding from your household at the same time?
YesNo

OTHER INFORMATION

Date of Care

Please respond to all questions:
Please leave this field empty.

1. If your dog is crate trained and forms part of its normal routine for the day, do you provide consent for your dog to be crated?
YesNo

2. Do you give consent for your dog to be in a designated room at the same time with dogs from a different household?
YesNo

3. Do you give consent for your dog to be walked outside the premises on a lead?
YesNo

4. Do you give consent for your dog to be taken to the secure dog field with other dogs from a different household?
YesNo

5. Do you give consent for your dog to be in the outside area at the premises with dogs from another household?
YesNo

6. Are you happy for your dog to be fed our treats?
YesNo

7. You consent to images of your dog to be uploaded to our social media and website?
YesNo

8. What are your dog's commands:

9. Is your dog possesive or protective of the following? (Select all that apply)
FoodToysChewsCollarYou or Your Family MembersNone of the Above

10. What are your dos and don'ts in your house (e.g. no dogs allowed on the sofa etc)?

11. Is your dog toilet trained?
YesNo

12. Has your dog ever bitten another dog or human?
YesNo

Any other comments or information about your dog that you feel might be helpful?

PLEASE NOTE THAT WE DO NOT PROVIDE FOOD. YOU (THE OWNER) NEED TO PROVIDE US WITH YOUR DOG'S OWN FOOD THAT WILL LAST THE DURATION OF THEIR STAY.

Acceptance

This agreement is made when signed, so that you accept the TERMS & CONDITIONS laid out under 'terms of agreement'.

I have read and accept the Terms and Conditions