New Client Enrollment ΔClient DetailsDog DetailsVaccination RecordsEmergency Contacts / ConfirmationFor the safety of all our guests and to be able to maintain a high level of service, we will try to accommodate last minute requests, however, space may not be available. We require all new canine guests to come in for a Meet & Greet appointment and then two trial days of daycare before an initial reservation can be booked. All vaccination records must be up-to-date and sent over at least 48 hours before the trial day of daycare.I am interested in Dog Day Care Overnight LodgingAre you an existing client? Yes NoLooking to start services on Number of Dogs to Enroll 1 2How did you hear about us?How did you hear about us? Referred by Client Dog Park Facebook Rescue Groups Saw Sign Training Class Vet’s Office Web Search *OtherName of Client Name of Vet Other Client Information(1) First Owner(1) First Name (1) Last Name (1) Phone/Mobile (1) Email (2) Second Owner(2) First Name (2) Last Name (2) Phone/Mobile (2) Email Mailing Address:Address Line 1 Address Line 2 City State – Select –AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWYZip Code Digital NotificationExamples of notifications that are sent; Vaccination Reminders, Transaction Receipts, After Visit Summary, etc. Enroll in Text Alerts? Yes NoText Notifications are sent as MMS messages. Standard message & data rates apply. Service Provider”> Service Provider – Select –AT&TBoostCricketMetro PCSNet10SprintT-MobileTrackPhoneVerizonVergin MobileXfinity*Other Service Provider”> Service Provider – Select –AT&TBoostCricketMetro PCSNet10SprintT-MobileTrackPhoneVerizonVergin MobileXfinity*OtherPreviousNextDog InformationDogs Name Gender – Select –MaleFemaleSpayed/Neutered? – Select –YesNoNo, Under six months of ageBreed Color Weight (lbs) Birthday (or best guess) *DOB-Month -Select Month –JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDOB-Day -Select Day –12345678910111213141516171819202122232425262728293031DOB-Year Health HistoryDoes your pet have any health issues? Yes NoIs your pet taking any medications or supplements? Yes NoIs your pet currently on a flea preventative? Yes NoDoes your pet have any allergies? Yes NoMedications/Supplements !Has your pet ever had a seizure? Yes NoHas your pet had an adverse reaction to…Topical Flea/Tick Protection? Yes NoAny Vaccinations? Yes NoHealth Detail Information Socialization InformationDoes your pet have issues with… Separation Anxiety Toy Aggression Food Aggression Leash Aggression Barrier Aggression People Cats Dogs Sensitivity When Touching Collar No IssuesWhere does your pet socialize with other pets? Dog Park Dog Daycare Street, leash only Home Isn’t SocializedIs your pet aggressive toward… Adults Children Cats Dogs No known aggressionHas your pet been to daycare before? Yes NoPrevious Daycare Reason for facility change: Has your pet ever bitten… Adult Child Another Animal NoDetails / Explain Has your pet jumped a fence/barrier? Yes NoSpecify Circumstances & Height Jumped Are there any behavioral concerns? Yes NoPlease tell us anything else that will help us care for your pet: Are you Enrolling a Second Dog? Yes NoSecond Dog InformationDogs Name Gender – Select –MaleFemaleSpayed/Neutered? – Select –YesNoNo, Under six months of ageBreed Color Weight (lbs) Birthday (or best guess) *DOB-Month – Select Month –JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberDOB-Day -Select Day –12345678910111213141516171819202122232425262728293031DOB-Year Health HistorySome description about this sectionDoes your pet have any health issues? Yes NoIs your pet taking any medications or supplements? Yes NoIs your pet currently on a flea preventative? Yes NoDoes your pet have any allergies? Yes NoMedications/Supplements !Has your pet ever had a seizure? Yes NoHas your pet had an adverse reaction to…Topical Flea/Tick Protection? Yes NoAny Vaccinations? Yes NoHealth Detail Information Socialization InformationDoes your pet have issues with… Separation Anxiety Toy Aggression Food Aggression Leash Aggression Barrier Aggression People Cats Dogs Sensitivity When Touching Collar No IssuesWhere does your pet socialize with other pets? Dog Park Dog Daycare Street, leash only Home Isn’t SocializedIs your pet aggressive toward… Adults Children Cats Dogs No known aggressionHas your pet been to daycare before? Yes NoPrevious Daycare Reason for facility change: Has your pet ever bitten… Adult Child Another Animal NoDetails / Explain Has your pet jumped a fence/barrier? Yes NoSpecify Circumstances & Height Jumped Are there any behavioral concerns? Yes NoPlease tell us anything else that will help us care for your pet: PreviousNextVeterinarian Contact InformationName of Clinic Clinic Phone Number Vaccination RecordsDo you have a Picture / File of your dog(s) vaccination records? Yes NoMethod of submitting reccords: File Upload Send via FaxUpload a scanned document of the vaccination records, or take a picture with your phone and upload it.Please fax vaccination records to: (734) 927-4517Please obtain a copy and Email them to us, or have your veterinarian office Email of Fax them to us.‘s RecordsFile Upload Choose File ‘s RecordsFile Upload Choose File PreviousNextEmergency ContactsContact 1 Name Contact 1 Phone Contact 2 Name Contact 2 Phone Contact 3 Name Contact 3 Phone I have read and understand the requirements for enrollment, and the information entered is accurate to the best of my knowledge. Previous Submit Form
