Exercise and Social Time Form

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Your name*

Email*

Phone*

Address*

Alternative emergency contact

Their contact number

Your Dog

Dog name*

Breed*

DOB*

Dog

Bitch

Neutered?

Yes

Any health isues? If yes, please specify

Vets

Vets phone

Worming date

Defleaing date

Vaccination date

Microchip number

Please upload a photo of your dogs vaccination card

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

Their own food only

Exercise

What exercise do you give your dog on a daily basis?

Select one

I would like my dog/s to be kept on the lead at all times

I would like my dog/s to be off lead only in secure areas, such as Nowton Park training venue

I would like my dog/s to be let off lead wherever suitably safe on daily walks

Sociability

Sociable with dogs/ other animals?

Yes

Notes

I am happy for my dog/s to mix with any dogs on the premises

Yes

Familiar with people/children?

Yes

Notes

Should my dog/s need emergency veterinary treatment for any reason I give permission for this to happen if I am not contactable up to a limit of

Insured?

Yes

Other

Insurance company

Insurance policy number

Anything else we should know about?

I agree to the terms and conditions.

Date

Print name

Signature

Signature field is empty.

I will inform East Anglian Dog Training & Grooming if my dog's needs change to affect these arrangements.

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07816 444 310

01449 706 152

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Next to the Walled Garden, Nowton Park, Bury St Edmunds, IP29 5LU

What3words: shout.mills.woven

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