The Dog House Day Care Membership Form Additional Dog

OWNER INFORMATION

Title (Mr/Mrs/Ms etc)

Name

First Last

Email Address

DOG BASIC INFORMATION

Name

Breed

Sex

Age

Birth Date

Colour

Desexed

Registration Number

Microchip Number

DOG MEDICAL HISTORY & HEALTH

Any medical conditions

Yes
No

Please specify

Recent/current injuries

Yes
No

Please detail

Any restrictions on movement

Yes
No

Please detail e.g. Dysplacia

Taking any medication

Yes
No

Please detail

Allergies/Food sensitivity

Yes
No

Please detail

Flea/worm

Yes
No

Date of last dose

Product used

DOG BEHAVIOUR

Are you happy for us to give your dog treats?

Yes

Is your dog anxious or frightened by any of the following:

Noises
People
Location
Objects
Situation

Has your dog ever…

Reacted negatively around food
Growled at someone
Escaped from your property
Bitten someone, or another animal

If yes, please give details

SOCIALISATION

How often does your dog socialise?

How does your dog react to other dogs on lead?

Any type of dog your dog automatically dislikes?

What games does your dog enjoy with other dogs?

Does your dog willingly share food/eat food near other dogs?

Does your dog enjoy playing with other dogs?

How does your dog react to other dogs off lead?

Any type of dog your dog automatically prefers?

What games does your dog dislike with other dogs?

Does your dog willingly share toys with other dogs?

TRAINING

Has your dog attended formal training?

Yes
No

If Yes please detail who with and to what level

PET SERVICES/PRODUCTS USED

Have you used a day care before (if Y please specify)

Have you used a groomer before? (if yes please specify)

Has your dog ever had a bad experience with any of the above? (If Y please detail)

Have you used kennels before (if Y please specify)

THE DOG HOUSE LIMITED SERVICES

To help us better understand you and your dogs needs, please indicate the type of services you are interested in. These details are used as part of our assessment / marketing and does not commit you to any services at The Dog House

DAYCARE

Frequency

Half or Full day

Preferred days

GROOMING

Full Groom

Basic Groom (wash, dry & nails)

Nails only

Security Check (Anti-Spam)