Auroras Explorers Dog Walking Client Form
Client Information
Your Name
First Name
Last Name
Email Address
example@example.com
Contact Number
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide if there are any entry requirements/instructions for your home, special check-in procedures, or any other information to be aware of:
Emergency Contact Name
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Pet Information
Please provide information regarding your pet(s) to be walked. If you are giving information from a multi-dog household, and require more than one dog to be walked please complete this form once per dog. The first dog name entered below will be who the form is regarding. Many thanks.
Is your dog neutered/spayed?
Yes
No
Unsure
Is your dog Microchipped?
Yes
No
Unsure
Microchip Number (if applicable):
How long have you owned your dog?
Please Select
Since separation from birth Sire
1 year +
2 years +
3 years +
4 years +
5 years or more
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Veterinary Information
Is your dog fully vaccinated?
Yes
No
Unsure
Date of last vaccination:
Flea & worming treatment up to date?
Yes
No
Unsure
Any medical conditions, allergies, or injuries?
Is your dog insured?
Yes
No
Veterinary Hospital Name
Doctor' s Name
First Name
Last Name
Doctor' s Contact Number
-
Area Code
Phone Number
Veterinary Hospital Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Behaviour & Temperament
Has your dog ever shown aggression towards people?
Yes
No
Has your dog ever shown aggression towards dogs?
Yes
No
Has your dog ever bitten another dog or person?
Yes
No
If you have answered 'yes' to any of the above questions in this section, please give details:
Is your dog nervous or reactive to anything?
How does your dog behave around children, livestock, and other animals?
Any other additional information about your dogs behaviours:
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Training & Handling
Basic commands your dog knows (including wording):
Recall reliability (1 - 10):
1:poor recall - 10:always responsive recall
Can your dog be let off the lead?
Yes
No
Does your dog require a muzzle?
Yes
No
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Walk Preferences
Please choose one or more:
Solo 1 hour walk
Solo 2 hour walk
Group 1 hour walk
Puppy/Dog Desensitisation Session
Home Drop-in Session
Other
Please choose one or more:
Mondays
Tuesdays
Thursdays
Fridays
Other
Preference to walk from your home or car travel to destination?
I'd prefer my dog to be walked from collection address
I am happy for my dog to be transported in the Auroras Explorers car/van
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Permissions & Agreements
May we use photos and videos of your dog on social media?
Yes
No
Do you give Auroras Explorers permission to seek emergency veterinary treatment if required?
Yes
No
In the unlikely event of a medical emergency:Please indicate your preference regarding life-saving first aid.
I give permission for Aurora’s Explorers Dog Walking & Pet Services to administer emergency first aid, including CPR, in line with current canine first aid training.
I give permission for Aurora’s Explorers Dog Walking & Pet Services to administer emergency first aid, EXCLUDING CPR, in line with current canine first aid training. I request that a Do Not Resuscitate (DNR) order be followed for my dog.
Do you consent to us holding keys (if applicable)?
Yes
No
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Signature
Submit
Submit
Should be Empty: