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Dec 16 16

Test Form Page

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Dog Day Care and Boarding Agreement

Name of Owner

City and ZIP

Home Phone

E-mail

Dog(s) Name

Birth Date

My Dog is

Male
Female
Spayed/Neutered or Under 6mo Old

Breed

Weight (lbs)

Color

Method of Flea Control (Must be on a flea control program and free of fleas):

Has this dog ever attended dog

If yes to above, where?

Are there any medical or behavioral issues reported? (Thunderstorm fears, destroys bedding, chewer, chases cats and squirrels)

If yes to above, describe:

Does this dog have any medical problems or physical ailments? (Seizures, asthma, arthritis, incisions, allergies, etc.)

If yes to above, describe:

Has this dog ever bitten a person, or attacked another dog?

Has this dog ever exhibited aggressive behavior towards people or other dogs?

If yes to above, how high was the fence?

Has this dog ever jumped a fence?

If yes to above, when and why?

Are the vaccinations current, including Bordetella (kennel cough)?

Please bring a copy of your dog\\\\\\\\\'s current vaccination records from your vet. Current vaccination for Rabies, DHLP-P, Distemper, and Bordetella required.

Name and Phone of Veterinarian

Food brought from home

While we will provide Nutro Products to feed your dog, if your dog requires a special diet, please bring your food in a sealable plastic container (such as Tupperware). We will label it the use of your dog only. The container will be returned to you upon pickup of your pet. We do have refrigeration and microwaves if it applies to the preparation of your pet’s meals.

Will this pet need any medication (pills, ointments) administered during the stay?

If yes, give instructions:

What condition does this treat?

Address

Work Phone

Cell Phone

Emergency Contacts (Name and Number)

Is anyone else authorized to pick up your pet?

By checking "Yes," you authorize Savvy Dog Daycare to release your dog to the person(s) listed below, and release The Savvy Dog from any and all responsibility:

Name(s):

Comments Off on Test Form Page

104 S. Defiance Street
Archbold, OH 43502

419.445.2999
419.445.2998 fax

Monday - Friday: 7:30AM - 7:00PM
Saturday: 9:00AM - 3:00PM
Sunday: by Appt.