Untitled Document

Fill out the sign-up form below entirely, or give us a call at 541-744-BARK for more information. I am registering for:
DAY CARE Let us know what day(s) and time you would like to drop off your pets:
NIGHT CARE Let us know what night(s) you would like to have your pets stay.

First Name: *
E-mail Address: *
Last Name: *
Street Address: *
City: *
State: *
Zip: *
Phone (Home): *
Phone (Work):
Emergency Contact (Home): *
Emergency Contact (Work):
How did you hear about us?
Have your pets stayed with us before? *	Yes No


Pet 1 Name:
Breed:
Color:
Gender:
Birthdate:
Neutered?
Size:
Bordatella:
DHLPP:
Rabies:

Pet 2 Name:
Breed:
Color:
Gender:
Birthdate:
Neutered?:
Size:
Bordatella:
DHLPP:
Rabies:


Veterinarian
Street Address:
City:
State:
Zip:
Office Phone:
Fax Number:
Diet Restrictions:	House Special Allergies
Does your dog require any medications? *	Yes No
Is your dog on a flea prevention program?: *	Yes No
Has your dog been sick recently? *	Yes No
If yes, what was the treatment?


How does your dog react to new people/dogs?

Does your dog have any sensitive areas on his/her body that are uncomfortable to the touch?

Is your dog overly frightened or nervous about anything?

How does your dog react to other dogs approaching when youre out on a walk? On lead:

How does your dog react to other dogs approaching when youre out on a walk? Off lead:

Has your dog ever jumped or climbed over a fence? If yes, how high was it?

Does your dog have problems in any of the following areas?
Mouthiness (chews on your hands, clothing) Excessive barking Chewing destructiveness Coprophagia (eating own feces or other dogs feces) Separation anxiety
What type of training has your dog had?
No training Trained yourself Puppy class Beginner obedience class Obedience class Private lessons
How do you currently exercise your dog?

How often does your dog get exercise?

Has your dog had any socialization with any other dogs? (Please explain. e.g. playing at dog parks)

Is your dog fearful or aggressive around small/large dogs?

Has your dog ever growled or snapped at anyone taking food or toys away?

Has your dog ever bitten a person or dog?

Is your dog crate trained?

What do you do with your dog when you are not at home?

Has your dog had any basic obedience training?

Tell us why you would like your dog to come to daycare:

Other comments or information about your dog that you feel might be helpful:


I HAVE READ THE LUCKYDOG CARE POLICIES & WAIVER DOCUMENTS *
What is the best # to reach you at?	Home Work
What is the best time to call?


* Required