Daycare Form

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Your name*

Phone*

Email*

Address*

Alternative emergency contact*

Relationship to owner

Their contact number*

Their email address

Their home address

The total number of dogs you own and names:

Your Dog

Dog name*

Breed*

DOB*

Dog

Bitch

Neutered?

Yes

No

Date neutered (if applicable)

Veterinary and Health

Any health issues? If yes, please specify

Any regular medication? If yes, please specify

Any food allergies? If yes, please specify

Any physical issues? If yes, please specify

Any behavioural issues? If yes, please specify

Vets*

Vets phone number*

Worming product and regime e.g. monthly, quarterly

Defleaing product and regime e.g. monthly, quarterly

Vaccination date

Kennel cough (optional)

Yes

No

If yes, kennel cough vaccination date

Please upload a photo of your dogs vaccination card

Microchip number

Season date (bitches only)

Should my dog/s need emergency veterinary treatment for any reason I give permission for this to happen if I (or my emergency contact) are not contactable up to a limit of *

Diet

Food brand, type and feeding details

My dog can have (tick all that apply)

Any treats

Peanut butter

Wheat free only

Grain free only

Refer to allergy section

Their own food only

Exercise

Any exercise restrictions:

Select one

I would like my dog/s to be walked on the lead at all times when away from the secure paddocks

I would like my dog/s to be walked and let off lead wherever suitably safe

I do not want my dog to be walked

Sociability

My dog is sociable with dogs?

Yes

No

Notes

My dog is sociable with people?

Yes

No

Notes

Anything else we should know about?

I will inform staff immediately if any of my dogs needs change.

I will inform staff if I alter my defleaing and/or worming regime and/or product. My dog can be crated for rest & mental stimulation periods. I will inform staff when my dog has their annual vaccination. I would like my dog to socialise with other dogs. I will keep all my contact details up to date with staff. I agree all of the information provided is correct.

I agree to the terms and conditions.

Date

Print name

Signature

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