Client InformationPlease complete and submit a registration for each dog you wish to enroll for Doggie Daycamp and/or for overnight lodging Please email vaccination record to firstname.lastname@example.orgName* First Last Phone Number*Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Dog's Name. Breed, Age, Approx. Weight(If Mixed, list suspected breeds)What age was your dog when you acquired them and how long have you owned your dog?Please describe your dog's flea/tick prevention None Prescription Non-Prescription Is your dog on a heartworm prevention and how often? None Yes, Year-round Yes, Summer Months Does your dog have any allergies, if so, please explainDoes your dog have any physical disabilities and/or medical conditions?Please Tell Us about your dog's Diet: (Type of Food, How Much, Schedule)Any Diet restrictions we need be considerate of?Are we allowed to give your dog treats?Where does your dog prefer to potty at home? (Pee Pad, Grass, Rocks, Mulch, Concrete, Etc.)Does your dog have any bathroom habits that are concerning?Does your dog have any areas on their body where they may be sensitive?What is your dog's favorite forms of affection? Where does your dog enjoy being petted?Which of the following best describes your dog's level of socialization with other dogs None – No knowledge of other dog interaction Minimal – On leash encounters only Moderate- Some off-leash playtime on occasion with visitor’s/neighbor’s/friend’s dog(s) Extensive – Regular visits to dog social events, off-leash dog parks, dog daycare, etc. What is your dog's response to other dogs? Ignores other dogs Happy to see other dogs Scared when around other dogs Reactive to other dogs(Lunges, Barks, Growls, Etc.) Other-To Be Discussed Has your dog experienced any issues while being in a leash free environment where other dogs are present? If so, Please explainHow frequently is your dog walked outside on a leash? Rarely 1-3 walks a week 4-7 walks a week Multiple walks daily Other-To be discussed How long would you suggest your walks last? Less than 30 minutes per walk 30-60 minutes per walk Longer than 60 minutes Which of the following best describes your dog's level of exercise at home Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogs. Couch Potato: Spends days sleeping, occasional walks and/or playtime with humans or other dogs. Moderate Exerciser: Long or multiple walks daily and/or regular playtime with human or dogs Athlete: Regular jogs/runs and/or regular participation in a dog sport activity such as agility, flyball, or Frisbee, etc. Has your dog ever climbed/jumped a fence? Yes No Has your dog ever escaped from your house or yard? If so, please explain the circumstancesHas your dog attended obedience training? No Obedience Classes Attended one group class Attended more than one level of group classes (beginner and intermediate, etc.) Dog was sent to a board and train program Private sessions in home Other-To Be Discussed Please select the gear that your dog wears while on leash Collar with Buckle Choke Chain Prong/Pinch Collar Harness Head Collar(Halti) Other Where does your dog sleep Inside Outside Inside & Outside Where does your dog sleep? Kennel-Crate Owner's Bed Dog Bed on Floor Free-roam Is your dog allowed on furniture at home? Yes No Which of the following behaviors does your dog display? Mouthing Biting/Chewing Barking Pulling Jumping/Lunging Digging Ignoring Commands Marking/Housetraining Are there any types of people your dog automatically fears and/or dislikes?Has your dog ever growled at someone? If so, please explainHas your dog ever bitten someone? If so, please explainHas your dog ever bitten another animal? If so, please explainPlease tell us how your dog reacts to thunderstormsDoes your dog enjoy playing with toys? Yes No Unsure Has your dog ever growled/snapped/bitten a human when they took the toy? Yes No Unsure Has your dog ever growled/snapped/bitten another dog when they took the toy? Yes No Unsure Please provide any additional input you feel would be important for our staff to know about your dogHow Did You Hear About Us? Drove By Google Website Social Media Word of mouth Veterinarian's Name, Address, Phone NumberEmailThis field is for validation purposes and should be left unchanged.