Dog Boarding Registration Form

Dog Boarding/ In Kennel Registration Form
Contact Information
Your Name

First NameLast Name
Contact Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact
Relationship
Emergency contact phone
Please list those whom are authorized to pick up your dog(s) if you are unable. Dogs will not be released to an individual that is not on your list.
Check In/ Check Out

Check in and check out are by reservation only. Any time before or after designated business hours will result in an additional overnight fee. Arriving past your designated pickup/drop off time will result in a late fee.
Check In Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Check Out Date & Time

MonthDayYear
Date
Hour MinutesAM/PM Option
Your Dog's Details
Your Dog(s)*
Dog's name
Dog's breed
Dog's age
Dog's weight
Sex

FemaleMale
My dog is

SpayedNeuteredIn tact
Physical description of dog
Where did you get your dog?
How old was the dog when you obtained him/her?
Any other dogs or animals in the home? If so, what kind of animal(s)?
Feeding Details

Please note that you are required to provide enough for for your dog's stay. If they run out and we are responsible for ordering more, you will be charged accordingly.
Brand of food
Please describe your dog's feeding schedule (amount and frequency):
Is your dog on a special diet that requires food to be refrigerated?

YesNo
If yes, please describe below:
Please list any allergies or food sensitivities:
Is your dog allowed to have treats here?

YesNo
Would you allow a frozen kong (peanut butter and plain greek yogurt) to be placed inside your dog's kennel from time to time?

YesNo
Health details
Is your dog on any medications? (Additional fee per day for administering medications)

YesNo
If yes, please list the medication name and dosage:
You give K9 Revolution permission to administer medication. (This applies to prescribed meds and over the counter meds. Communication with K9 Revolution will take place first, prior to any over the counter meds being given).

YesNo
Is your dog currently displaying any symptoms such as coughing, sneezing, vomiting or diarrhea?

YesNo
Does your dog have any previous or current injuries or physical conditions (cut/wounds, scars, limp, etc)

YesNo
If yes, please describe:
Has your dog been ill in the last 30 days?

YesNo
Does your dog have any health concerns (allergies, heart condition, diabetes, etc)?

YesNo
If yes, please explain:
Is your dog on Heartworm preventative?

YesNo
If so, what kind? What date is it given?
Is your dog on flea/tick medication? (Not required but recommended to be one something)

YesNo
If so, what kind? What date is it given?
Is your dog free of parasites/fleas/ticks?

YesNo
I understand that K9 Revolution will not be held liable or responsible if you dog falls ill during their stay or after.

I understandI do not understand
Please provide the most recent vet records/vaccines/titers INCLUDING a negative fecal test (including Giardia) that must be done at least 30 days prior to being dropped off. *

Cancelof
Behavior
Please check all that apply to your dog's personality

OutgoingTimidAffectionateReservedProtectiveFriendlyAggressiveSubmissivePlayfulConfidentIndependent
Please check all that apply to your dog's behavior/habits

ChewerSeparation AnxietyPotty trainingSelf mutilatesBolts out the doorExcessive markingEats fecesMountingIgnoresPulls on the leashExcessive barkingPlay biting/mouthinessGrowlingJumpingUnrulyDigsRuns awayResource guarderWhiningChasing (kids, animals, cars)NippingSteals things
Is your dog crate trained? If no, please see next question.

YesNo
My dog is a puppy and not yet crate trained and this has been disclosed to K9 Revolution. For an additional fee, crate training will be worked on while here.

YesNoN/A
What kind of crate does he/she usually stay in?
Has he/she ever tried to break out of a crate?

YesNo
If yes, please explain:
Is your dog a chewer?

YesNo
Is your dog a digger?

YesNo
Do you want special bedding in your dog's crate during their stay? (Something other than the crate bottom like a mat or soft bed)

YesNo
Do you understand that there are considerable risks involved in leaving bedding inside a kennel while your dog is unattended or resting there? In answering below, you understand that the bedding can be destroyed and can be fully or partially ingested by your dog causing life threatening health issues or even death. You assume sole responsibility for the behavior of your dog and forever release, hold harmless, and indemnify K9 Revolution, LLC, its officers, employees, trainers, and other agents, from any harm or damage caused by you or your dog to any person or persons or property at any time. You further release, hold harmless, and indemnify K9 Revolution, LLC, its officers, employees, trainers, and other agents, from any harm caused to your dog as a result of leaving these special items inside.

Yes, I understandNo, I don't understand
Is your dog a fence jumper?

YesNo
Is your dog allowed on furniture?

YesNo
Does your dog like to ride in the car?

YesNo
Does your dog play well with other dogs?

YesNo
Do you wish for your dog to socialize with other appropriate dogs while boarding/training?

YesNo
If yes, do you understand the potential risk associated with this?

YesNoN/a (Dog will not be socialized/interact with others)
I understand that my dog stays in an air conditioned, designated kennel building, in their own crate, on the property of K9 Revolution. The facility is not equipped with an automatic fire protection sprinkler system, but does have a temperature monitor where K9 Revolution can check kennel temperatures 24/7 and be notified of any outages. K9 Revolution does leave the property at times where animals are without supervision, but in safe and secured quarters and are tended to once back on property.

I understandI do not understand
Choose all that apply. What does your dog do when seeing another dog while on leash?

IgnoresShows interest but keeps walkingExhibits playful behaviorOverstimulatedGrowls/lungesTries to hideBarksOut of controlOther
Has your dog ever bitten another dog?

YesNo
If yes, please explain. Did either dog require medical attention?
Has your dog bitten another person?

YesNo
If yes, please explain. Did it require medical attention?
Choose all that apply. Is your dog reactive to dogs or people? (Barks, growls, lunges)

DogsPeopleOther animals
If yes, please describe your dog's typical behavior and what triggers reactivity:
Is your dog a resource guarder? (Can be food, toys, people, space)

YesNo
If yes, please explain:
How does your dog respond when someone comes into your home?
How does your dog respond at the vet or groomer?
How does your dog respond when hearing a loud noise?

No startleStartles, but recoversStartles and tries to hideOther
Does your dog let you handle him/her? (Brushing, touch feet, check teeth)

YesNo
Does your dog nudge you for attention?

YesNo
Any additional notes about your dogs (aggressive tendencies, possessions, level of obedience etc.)
Training
What are your 3 main goals for your dog with in kennel training? (Does not apply to dogs boarding. Type N/A if boarding).
Has your dog ever had any kind of training?

YesNo
If yes, what kind? (Private lessons, group class, in kennel)
Do you understand K9 Revolution uses a variety of equipment/techniques including food, toys, praise, affection, play, prong collars, remote collars, slip leashes, martingales, etc. and that K9 Revolution will evaluate which training tool/equipment/motivation will be most suitable for your dog.

YesNo
What do you think motivates your dog most?

FoodToysPlayAffectionPraise
How do you discipline your dog?
How do you connect with your dog?
Does your dog know any commands?

YesNo
If so, what do they know?
Do they perform commands consistently and reliably?

YesNo
Do you have to repeat commands?

YesNo
Choose all that apply. What kind of equipment do you currently use?

Flat collarHarness (attaches to back)Harness (attaches to chest)Head collar (Halti, gentle leader)Chain collar (choke chain/slip)MartingaleProng collarRemote collarOther
What type of daily activities or exercise does your dog get?
How many walks does your dog get per week?
Do you want your follow up lesson (that needs to be scheduled within 6 weeks of go home) to be at K9 Revolution’s location or your location?

K9 Revolution’s locationMy home (mileage NOT included)
Vet Details
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I, the undersigned, hereby acknowledge and agree that all the information in this application is complete and accurate to the best of my knowledge. I further attest that if I am not the sole owner of the dog subject to this application that my signature is sufficient to enter into this application on behalf of any other owner.
Date

MonthDayYear
Date
Your Signature

Clear
Should be Empty:

Dog Boarding/ In Kennel Registration Form

Contact Information

Check In/ Check Out

Your Dog's Details

Feeding Details

Health details

Behavior

Training

Vet Details