wiggleswagsnwondersapplication

Wiggles Wags N' Wonders Enrollment Application Form

Accuracy of information provided: By signing this form I certify that all information provided and disclosed by me in this application form is complete and accurate.

Pet Parent Information:

First NameLast Name

Address:

Unit/Apt:

Province:

Home Phone:

Work Phone:

Cell Phone:

E-mail Address:

Emergency Contact:

First NameLast Name

Address:

Unit/Apt:

Province:

City:

Postal Code:

Home Phone:

Work Phone:

Cell Phone:

Email Address:

example@example.com

Name of Veterinary office:

Phone Number of Veterinary office:

Address of Veterinary office:

Dog's Name:

Dog's Nickname:

Breed:

Color:

Weight:

Age:

Birthday:

Male/Female:

Spayed/Neutered:

Flea control treatment:

Please describe any medical conditions or allergies that your pet has:

Are there any treats we should NOT offer your dog:

Is your dog required to take medication during their stay?

If yes, please explain dosage and frequency?

Does your dog have any medical restrictions in his or her activities? if yes, please explain:

Rate your dog's energy level (1 being very mellow and 10 being a total energizer bunny)

Has your dog ever been to doggy daycare before?

If yes, how did they like it?

How does your dog react to other dogs?

Has your dog ever bitten another dog or person before? If yes, please explain situation

Is there any situations or circumstances that your dog is uncomfortable with?

What kind of toys does your dog most like to play with?

Is your dog toy, food, treat or water bowl possessive? If yes, please explain:

Describe the best way to help calm your dog down when he/she is in an anxiety state:

Wiggles Wags N' Wonders shall not be held responsible for any injury or disease your dog may incur during their stay with us. We will always do our utmost best to make sure the facility is as clean and comfortable for the dogs as possible.

Date

Name (please print)

Signature