- 4 Paws Playhouse - Application For Daycare

Application

Please complete this questionnaire, so that we may properly take care of your dog. Thank you.

All items must be completed in order to submit the form.

Owner Information:
Owner's Name(s):
Address:
City:
Zip Code:
Home Telephone #:
Work Telephone #:
Cell Phone #:
Email Address:
How did you hear about 4 Paws Playhouse Corp.?
Dog Information:
Dog's Name:
Breed/Mix:
Age:
Birth Date:
Color:
Sex:	Male Female
Weight:
Is your dog spayed/neutered?	Yes No
At what age?
Veterinarian Name:
Office Name:
Address:
City:
Phone:
Where was this dog acquired?
How long has this dog lived with you?
What food do you feed this dog?
Training Information:
Has your dog attended training classes?	Yes No
What commands does your dog know and respond to?
Is your dog crate trained?	Yes No
If so, when is the crate used (naps, bedtime, while at work? etc)
Medical History:
Does your dog have any allergies?	Yes No
If so, how are they being treated?
Does your dog have any problems with ear infections?	Yes No
Does your dog regularly take any medications?	Yes No
If so, please explain:
Does your dog have any special dietary requirements or restrictions?	Yes No
If so, please explain:
Rabies Vaccination Expiration date?
Distemper Vaccination Expiration date?
Kennel Cough Vaccination Expiration date?
Negative Fecal Test date?
Is your dog on a regular heartworm/parasite prevention treatment?	Yes No
If so, which program?
Is your dog on a regular flea prevention treatment?	Yes No
If so, which program?
Have sore paws/pads ever been a problem?	Yes No
Social History:
What other types of pets are in your home?
Are there children in your home?	Yes No
If so, what ages?
Has your dog ever been in a social play group (dog park, friend’s home, etc.)?	Yes No
If so, what type, or what situations?
Does your dog exhibit any of these anti-social behaviors?	Growling Biting Other:
Behavior:
How would you describe your dog’s activity level at home?
Is your dog housebroken?	Yes No
Are doggy pads used at home?	Yes No
Has your dog ever jumped a gate?	Yes No
If so, what height?
Is your dog toy protective?	Yes No
Is your dog water bowl protective?	Yes No
Other:
Do you have any special instructions?
Emergency Contacts (must be reliable people that can either pick up your pet and/or make a decision in case of an emergency.) If owner is not available, please contact:
Name:
Phone:
Alternate:
Name:
Phone: