UNLEASHED and lovin’ it!
Registration Form
Client Name:
*
Additional Client Name:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone #1 Name:
*
Cell Phone #1:
*
May we add you to our text alerts, news & updates list?
*
Yes
No
Cell Phone #2 Name:
Cell Phone #2:
May we add you to our text alerts, news & updates list?
Yes
No
Home Phone
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Employer
E-mail Address
*
example@example.com
May we add you to our email list?
*
Yes
No
Emergency Contact Information
Other than listed above
Name
*
First Name
Last Name
Relationship
*
Home Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
Cell Phone
-
Area Code
Phone Number
Who besides yourself is authorized to pick-up your pet(s)?
1: Name
*
First Name
Last Name
1: Relationship
*
1: Phone
*
-
Area Code
Phone Number
2: Name
First Name
Last Name
2: Relationship
2: Phone
-
Area Code
Phone Number
3: Name
First Name
Last Name
3: Relationship
3: Phone
-
Area Code
Phone Number
COMMUNICATION
Under what circumstances would you like to be contacted during your dogs stay?
*
Behavior change
Not Eating
Vomiting
Diarrhea Scratch
Small wound
Fight without Injury
Fight with Injury
Would you prefer...
*
Phone Call
Text Message
Email
#1 PET INFORMATION
Name
*
Breed:
*
Spayed/Neutered
*
YES
NO
Colors/Markings:
*
Birthday (or day celebrated):
*
-
Month
-
Day
Year
Nicknames:
*
#2 PET INFORMATION
Name
Breed:
Spayed/Neutered
YES
NO
Colors/Markings:
Birthday (or day celebrated):
-
Month
-
Day
Year
Nicknames:
Medical Information
Veterinarian Clinic / Doctor:
*
Does your pet take any medications?
*
NO
YES
Medications
*
How do you administer your dogs medication?
*
Stuff It
Peanut Butter
Pill Pocket
Cheese
Other
Does your dog have any allergies?
*
NO
YES
Allergies
*
If your dog is anxious would it be okay to use any of the following?
*
ThunderShirt
Natural Calming Treats
Natural Calming Spray
Covered Crate/Kennel
Other
If you dog is not eating during their stay, what can we do to entice them to eat?
*
Hot Water
Broth
Yogurt
Pumpkin
Sprinkles
Other
Additional Information
How did you hear about UNLEASHED and lovin’ it!?
*
Where did you get your pet?
*
How long have you owned you pet?
*
Are there other animals in your household?
*
NO
YES
Other animal in your household
*
Does your dog destroy toys or bedding?
*
NO
YES
Has your dog ever jumped, climbed or went under a fence?
*
NO
YES
What type of bowl does your dog normally eat from?
*
What basic commands does your dog know?
*
Sit
Stay
Down
Off
Come
Give/Drop
Trainer used?
*
Is your dog crate trained?
*
NO
YES
Signature
Submit
Should be Empty: