Pet Care/Training Information Form

PETCARE/TRAINING FORM
A. OWNERSHIP INFORMATION ABOUT THE DOG
Name of Owner(s) of the Dog*
Address*

Street Address

Street Address Line 2

CityState

Zip
Home/Work Telephone
Cell Phone
Email Address*
example@example.com
B. INFORMATION ABOUT THE DOG /DOGS
Breed*
Variety/Color*
Gender*
Call Name*
Date of Birth*

MonthDayYear
Date
Microchip number
SECOND DOG (IF APPLICABLE)
Breed
Variety/Color
Gender
Call Name
Date of Birth

MonthDayYear
Date
Microchip Number
THE ABOVE-DESCRIBED DOG/DOGS IS REFERRED TO HERIN AS "THE DOGS" OR "SAID DOGS
C. HEALTH INFORMATION ABOUT THE DOG/DOGS

Please distinguish if the dogs are on different diets
Regular Diet (BRAND)
Supplements
Feeding Procedure
Chronic Illnesses
Medications
Procedure For Medications
Microchip # If applicable
Allergies: (Medications, environmental)
Date of Last Heartworm Test

MonthDayYear
Date
If the Dog is on regular heartworm preventative, state the brand name (for example, Heartgard or Interceptor)
and date of administration each month

MonthDayYear
Date
Canine Influenza

Rabies (Copy Required)Adenovirus type 2DistemperBordatellaParvovirusParainfluenzaType option 7
Proof of Rabies/ Or letter from veterinarian acknowledging not in the best interest of dog. *

Cancelof
Proof of Rabies for 2nd Dog/ Or letter from veterinarian acknowledging not in the best interest of dog.

Cancelof
Name and Address of Veterinarian
Telephone Number of Veterinarian
D. BEHAVIOR INFORMATION ABOUT THE DOG
Unusual Habits (such as climbing, digging, anxiety, swallowing objects, eating food too fast etc.)
Describe Fully Previous Displays of Aggression of ANY TYPE (including food aggression, cage aggression, or aggression toward other animals or people, whether provoked or unprovoked) add attachment if more space is needed.
FEES. If the dog will be staying for a period of time over seven (7) days, a deposit of 30% of the estimated bill may be required at drop off. The Owner or Responsible Person agrees to pay fees for services performed as specified on Training and Conditioning sheet. A final itemized bill for all services and fees will be given to owner. Owner or Responsible Person agrees to pay the bill and all outstanding balances if a deposit has been left, upon pick up of dog. If the bill is not paid upon pick up of dog, a penalty fee of 10 % will be added to invoice per month. Owner or responsible party agrees that credit card payments will reflect a 4% accounting fee. Should costs of collection incur, Owner or Responsible Person agrees to pay such costs, including a reasonable attorney's fee.
Owner or Responsible Person Signature

Clear
Print Name
Date

MonthDayYear
Date
Should be Empty:

PETCARE/TRAINING FORM

SECOND DOG (IF APPLICABLE)

THE ABOVE-DESCRIBED DOG/DOGS IS REFERRED TO HERIN AS "THE DOGS" OR "SAID DOGS