Church Ranch Veterinary Center Daycare Registration Form
If you would like for your pet to participate in group play, please make sure that you have filled out the pet registration form.
Cell Phone Number
Please enter a valid phone number.
If different, please list veterinarian name & veterinary clinic where vaccine certification can be obtained. Please include the family name your pet is under:
Behavior with people?
Behavior with other pets?
Has your pet ever bitten a human or another pet?
Please explain situational triggers:
Has your pet ever attended daycare at another facility before?
Does your pet have a history of diarrhea or vomiting when change or stress occurs?
Do you give permission to withhold your pet’s food for a day should he/she have diarrhea or vomiting?
Has your pet ever tried to escape by (check all that apply):
Digging under fences
Chewing walls or door frames
Does not try to escape
Has your pet ever tried to escape from (check all that apply):
Date of last administered flea & tick medication
Does your pet have any allergies or medical conditions? If yes, please explain:
Has your pet been microchipped? If yes, it is our practice to scan all new patients for identification microchips. If a pet is lost, contact information provided on this form may be given to the appropriate recovery service in order to reunite pets with microchips to their registered owners.
I agree to allow the contact information on this form to be given to a recovery service in the event that my pet(s) become lost.
I have read and agree to the policies and procedures and have verified the information listed above.
Should be Empty: