| Date: |
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| Referred by: |
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| Name: |
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| Home Phone: |
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| Work Phone: |
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| Cell: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Driver's License: |
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| E-mail: |
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| Pet Name: |
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| Age: |
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| Birthdate: |
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| Sex: |
Male Female |
| Breed: |
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| Vet: |
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| Phone: |
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| Emergency Number (if you had a problem returning from a trip, who would take your dog): |
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| Proof: |
Rabies Distemper Parvo-Virus Bortadella
Spayed/Neutered |
| Where does your dog normally sleep? (i.e., on your bed, in a bed in your bedroom, in a crate, etc.) |
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| How is his/her day time spent? |
With other animals Other Humans Mostly alone Never
alone |
| How would you describe your dog's personality (check all that apply)? |
Aggressive Playful Easygoing
Temperamental Passive Uneven
Unpredictable Other |
| Is your dog house broken? |
Yes No Somewhat |
| Is your dog likely to have accidents in the house? |
Yes No |
| Chew on furniture? |
Yes No |
| Other Behavior challenges? |
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| Is your dog likely to try to dig out of fenced areas? |
Yes No Not sure |
| Is your dog likely to try to jump a 6 foot fence? |
Yes No Not sure |
| What is your pet's food routine? How often does he/she eat?
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| Is your dog allowed to have human food?
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| Does your dog have any food allergies? |
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| If yes, please indicate: |
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| Please describe your pet's social experiences (check all that apply) |
| Dog Park: |
Occasionally Weekly Monthly Never |
| Plays with other dogs: |
Occasionally Regularly Daily Rarely Never |
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| Describe your dog's behavior towards other dogs (check all that apply): |
Playful Shy Aggressive Attacking Unpredictable Not sure |
| Has your dog been professionally trained? |
Yes No |
| Successful? |
Yes No |
| Name/Contact for trainer (if applicable) |
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| Did your dog ever bite anyone?: |
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| Did your dog ever bite another dog? |
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| What kind of flea control do you use? |
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| Date of most recent flea treatment: |
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| Language used for "go to the bathroom" |
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| What are your major concerns about taking your dog to Daycare or Boarding? |
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| What Pet care options have you used in the past (check all that apply)? |
Kennels
In home pet care
Friend/Family |
| What has worked/not worked? |
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| Please indicate special routines or activities that make your dog especially happy (examples:loves having tummy rubbed, loves playing with me every morning before work, etc.) |
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| Anticipated pet care requirements: (check all that apply) |
| Daycare: |
Hourly
Daily
Weekly
Monthly |
| Overnight Boarding |
1 or 2 days
3 days or more
Weekly
Monthly |
| SPECIAL NEEDS: Please let us know about any special needs of your dogs, including,
food, medicine, health, psychological or social issues: |
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| Love Dogs Camp Newsletter |
Please subscribe me to Love Dogs Camp's free Newsletter which provides updated information and research to help you take better care of your dogs
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| By pressing submit, I hereby acknowledge the foregoing information is true and correct
to the best of my knowledge. |
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