New Client Submission Form and Contract
Owner Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Additional Owner
First Name
Last Name
Phone Number
Please enter a valid phone number.
Emergency Contact Name
*
*must be someone other than owner(s)
Emergency Contact Phone Number
*
Please enter a valid phone number.
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Pet Information
Dog Name
*
Breed
*
Gender | **must be spayed or neutered if 6 months or older**
*
Male - Neutered
Male - Intact
Female - Spayed
Female - Intact
D.O.B. (or best guess)
*
/
Month
/
Day
Year
Date
Weight (approx.)
My dog is from a...
*
Rescue or Shelter
Breeder
Friend or Family Member
Other
How long have you had your dog?
*
Pet Medical Information
Please let us know of ANY medical conditions or concerns below.
Be sure to include any recent surgeries, chronic illnesses, pain, etc.
If your dog is currently taking any medications (aside from flea/tick + heartworm preventatives), please list and describe them below.
Does your dog have any known food allergies?
*
Yes
No
If yes, please list them below.
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Pet Behavioral Information
Please give us as many details as possible - the more information we have, the better!
Has your dog attended dog daycare previously?
*
Yes
No
If yes, please describe the experience.
If you feel comfortable, please also include the name of the facility and/or describe it (large, outdoor, small, indoor, etc.)
If your dog has not attended daycare, has your dog been socialized with multiple dogs off-leash before?
Yes
No
If yes, please describe the experience.
Dog Behaviors | *please select all that apply
*
leash reactive
barrier reactive
vocal (barks, whines, etc.)
has separation anxiety
shy/timid
afraid of new people
escape artist
destructive
food aggressive
resource guarder (water, toys, etc.)
none of the behaviors apply to my dog
Can your dog be in a kennel or crate?
*
Yes
No
How would you describe your dog's play style? *please select all that apply
*
obsessed with other dogs and would play all day, non-stop if allowed
more submissive -- rolls on back, licks faces, etc.
pretty rough -- a lot of neck grabbing, wrestling, etc.
easy going -- gentle playing with self-regulated breaks
mounts other dogs frequently
"fun police" -- herder/tries to interrupt other dogs who are playing together
"sideliner" -- barks non-stop at other dogs playing in order to join in
loves to be chased
cannot self-regulate and will most likely need short breaks
prefers only one playmate at a time
plays with anyone and everyone
very nervous / does not engage in playing
my dog has never interacted with other dogs before
Has your dog ever displayed ANY type of aggression toward another dog? This includes, but is not limited to: snarling, growling, lunging, snapping at or has bitten.
*
Yes
No
If yes, please explain the situation.
Be sure to describe it in FULL DETAIL.
Has your dog ever displayed ANY type of aggression toward a human? This includes, but is not limited to: snarling, growling, lunging, snapping at or has bitten.
*
Yes
No
If yes, please explain the situation.
Be sure to describe it in FULL DETAIL.
Has your dog ever been attacked and/or involved in a fight?
*
Yes
No
If yes, please describe the situation. Please be sure to include how long ago and how your dog has responded to other dogs since the incident.
Be sure to describe it in FULL DETAIL.
Is there anything else that we should know or you would like to share about your dog?
*
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Pet Vaccination Records
Required vaccinations | Bordetella, Distemper (all rounds completed) & Rabies (must include the Rabies Certificate). You may also email them to us at info@just4pawsphilly.com if that is preferrable!
Please upload the vaccination records that show due dates for BORDETELLA, DISTEMPER and include the RABIES CERTIFICATE (must have vet's signature and/or license number on it).
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Per PA State law, we must have a copy of the RABIES CERTIFICATE, the document that would have come with the tag and must have the vet's signature and/or license number.
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Client Contract
Please read the Client Contract below and sign when you are finished.
If below says "No preview available," please try clicking inside the box and then "Refresh PDF"
Signature
*
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Daycare Policies & Procedures
Please be sure to read these thoroughly! You can also save the image for future reference!
I have read and agree to the policies stated above.
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