Client Registration & Pet Intake Form
The Crate Escape - Doggy Daycare & Boarding Service
4803 34th CT SE, Lacey, WA 98503 507-848-0319 thecr8teescape@gamil.com
Client Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Emergency Contact Name and Phone Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Pet-care Instructions
Please list all medications below along with instructions for the frequency and amount to administer for each one.
*
How many times a day does your dog eat? How much food do they get per meal?
*
Does your pet have an insurance policy? If so, please write the policy info below.
*
Is anyone else allowed to pick up your dog? If so, please name them below.
*
How did you hear about The Crate Escape?
*
Pet Information
Name
*
First Name
Breed
*
Male or Female?
*
Weight
*
Date of Birth if Known
*
Veterinary Office and Phone Number
*
Behavior and Temperament Information
Does your dog have any food allergies? If so, please explain down below.
*
Does you dog have food/toy aggression issues? If so, please explain in detail.
*
Does your dog show aggression or dominance over other dogs? If so, please explain in detail.
*
Does your dog have any behavior or temperament issues? If so, please list in detail.
*
Does your dog try to escape from enclosed areas? If so, please explain in detail.
*
Anything else you would like me to know to best care for your dog?
Required Vaccinations
Rabies Vaccination Expiration Date
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Month
-
Day
Year
Date
Bordetella Vaccination Expiration Date
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Month
-
Day
Year
Date
DPP Vaccination Expiration Date
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Month
-
Day
Year
Date
Heartworm Medication Expiration Date
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Month
-
Day
Year
Date
Flea and Tick Medication Expiration Date
-
Month
-
Day
Year
Date
Submit
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