VIPaws LLC New Client Application Form

New Client Application Form
Thank you for your interest in VIPaws. Please complete the section below so we can get to know you better.

If you have multiple pets, please complete one application per pet.

A $30 Rush Fee will apply to any evaluation day scheduled 10 days or less prior to sleepover check in.
Information About You
Owner's Name*

First NameLast Name
Dog's Name*
Owner's Email*
Confirm Email*
Cell Number*
Home Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Number*
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is there a second owner?*

YesNo
2nd Owner's Name

First NameLast Name
2nd Owner's Email
Confirm Email
2nd Owner Cell Number
2nd Owner Home Number
2nd Owner Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Number
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Individuals authorized to pick up your dog:*
Emergency Contact

In the event that we are unable to contact you, please list any emergency contacts. These individuals should be people you trust to make medical decisions onbehalf of your pet.
#1 Emergency Contact Name*

First NameLast Name
#1 Emergency Contact Cell*
#1 Emergency Contact Work*
#2 Emergency Contact Name*

First NameLast Name
#2 Emergency Contact Cell*
#2 Emergency Contact Work*
Veterinarian's Office*
Veterinarian's Name*
*It is highly recommended that you keep your credit card on file with your vet in the event of an emergency. Is your credit card on file with this vet?*

YesNo
Veterianarian's Phone*
Veterinarian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Service Needs

Please tell us what services and dates you are looking for and we will do our best to accommodate your reservation needs. An email response will be sent within 48 hours to verify availability and set up an evaluation day.
Doggie DaycareDoggie BoardingBoth
Check all that apply...*

My dog has been to daycare beforeMy dog has NOT been to daycare beforeMy dog has boarded beforeMy dog has NOT boarded before
Preferred Evaluation Date: (Evaluations Performed Monday - Thursday)*

MonthDayYear
Preferred Evaluation Drop Off*
Preferred Evaluation Pick Up*
Requested Boarding Check In Date

MonthDayYear
Requested Boarding Check In Time
Requested Boarding Check Out Date

MonthDayYear
Requested Boarding Check Out Time
For Afternoon check out, add $40 daycare service to last day of boarding and choose a time below
All dogs must have a Quick Release Martingale Collar.

For more information on what is a Quick Release Martingale Collar, please click on the link below.

http://www.myvipaws.com/quick-release-martingale-collar

We have this collar available for purchase in black, red, deep purple, raspberry pink, and blue. Our Peite size is $11, Small $12, and Medium $13. We can fit your dog for the collar and bump them up to the next size if needed.
YesNoMaybe
If yes, which color would you prefer:
Information About Your Dog

We care and want to get to know your dog. Please complete the questions below so we may be best of service for you and your dog.
Dog's Name*
Neutered MaleSpayed FemaleIntact MaleIntact Female
Dog's Breed(s)*
Approximate Weight*
Approximate Age*
Birthday: (month/day/year)*
My dog has lived with me for less than a monthMy dog has NOT lived with me for less than a month
How did your dog become a part of your family? (Please provide any relevant background information, such as history of abuse, lack of socialization, etc.)*
My dog*
My dog is an*
Potty trained?*
Normally goes potty*
My dog's energy level is*
How often does your dog go on walks?*
Average length of walk*
What is your dog's walking style?*
Any training?*
Any known commands/tricks?
Check all that apply to your dog's personality...*

AffectionateSubmissiveGentleReservedConfidentPlayfulLoves to be vocal (ex. bark, howl, sing, etc.)ExcitableIndependentPushyOutgoingClingyFearfulAnxious
Please list any fears or sensitivities (ex. Lightning, fireworks, tall men, thunder, doesn't like ears or feet touched, etc.)*
Does your dog engage in any unusual or repetitive behavior?*
Check all that apply... My Dog has shown aggression towards...*

Large DogsSmall DogsAdultsChildrenOthers When Food is PresentOthers When Possessions are PresentMy Dog Has Never Shown Aggression
If yes, please explain in detail
Has your dog ever bitten another human or pet?*
If yes, please explain in detail
Please list any old or current health concerns and/or injuries:*
Please list any allergies and/or medications along with specific details:*
Feeding Instructions
Name of Food:*
Amount Given Per Meal / Number of Meals Per Day:*
Typical Feeding Time of Meals:
Feeding Instructions:
At feeding time, your dog...*
Vaccinations

VIPaws LLC requires all dogs to be up to date with DHLPP (Distemper, Hepatitis, Leptospirosis, Parainfluenza, Parvovirus) and Bordatella (Kennel Cough) vaccinations. Please attach proof of current vaccination through vet records or invoices. You may also call your vet to have them email proof of vaccinations and flea, tick and heartworm preventatives directly to us at VIPawsLLC@gmail.com
Attach Vaccination Record

Upload a File

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Proof of Flea, Tick and Heartworm Preventatives

VIPaws LLC requires all dogs to be on current flea, tick, and heartworm preventatives. Please select your current preventative method and provide proof. Examples of proof include a receipt/invoice of the purchase or a clear picture of the remaining dosages with the product name clearly visible. A picture of a box does not count as we are unable to properly account for how many dosages to credit you for.

NOTE: ComboGuard, Trifexis, Comfortis, Advantage, and Sentinel do NOT cover ticks. Please contact your vet for a recommended tick coverage option.
Name of Flea Preventative*
Date Last Administered*

MonthDayYear
Proof of Flea Preventative

Upload a File

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Name of Tick Preventative*
Date Last Administered*

MonthDayYear
Proof of Tick Preventative

Upload a File

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Name of Heartworm Preventative*
Date Last Administered*

MonthDayYear
Proof of Heartworm Preventative

Upload a File

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Questions/Requests
How did you hear about us?*
By checking this box, I certify that I understand and my dog meets all requirements listed on MyVIPaws.com to utilize VIPaws services.*

Yes
Enter the message as it's shown*
Should be Empty:

New Client Application Form

Information About You

Service Needs

Information About Your Dog