| Owner's Information |
|
| Last Name: * |
|
| First Name: * |
|
| Address Line 1: * |
|
| Address Line 2: |
|
| City: * |
|
| State: * |
|
| Zip Code: * |
|
| Home Phone: * |
|
| Work Phone: |
|
| Cell Phone: |
|
| E-mail Address: * |
|
| Fax: |
|
|
|
| Emergency Contact |
|
| Emergency Contact Name: * |
|
| Emergency Contact Telephone: * |
|
| *Veterinarian Name: |
|
| Veterinarian Address Line 1: * |
|
| Veterinarian Address Line 2: |
|
| Veterinarian Office Telephone: * |
|
|
|
| Basic Information |
|
| How did you hear about Flying High Pet Resort?: |
|
| What is/are the reason(s) you want your dog to attend?: * |
|
| Will your dog be here for a short-term or long-term stay?: * |
|
| From and To day/time for your dog's stay?: * |
|
|
|
| Pet Information |
Please complete a separate form for each dog. |
| Dog's Name: * |
|
| Breed: * |
|
| Gender: |
|
| Date of Birth: * |
|
| Weight: * |
|
| Spayed or Neutered: * |
|
| Rabies License Number: * |
|
| Health Condition (e.g. allergies, physical limitations, medical issues, etc.): * |
|
| Medications (please list medication name, dosage, and administration): * |
|
| Special Feedings (Owners must supply food -- please indicate amount and time): * |
|
| Date dog was acquired: * |
|
| If dog was adopted, do you have knowledge of your dog's history? If so, please explain: |
|
|
|
| Health & Grooming |
|
| Does your dog have a flea problem?: * |
|
| Does your dog have hip dysphasia?: * |
|
| Does your dog have any activity restrictions?: * |
|
| Does your dog like to be brushed?: * |
|
| Does your dog negatively react to having his/her nails clipped by you or anyone else?: * |
|
| Does your dog have any sensitive areas on his/her body? If Yes, please explain: * |
|
|
|
| Behavior |
|
| How does your dog behave around children?: * |
|
| How does your dog behave around strangers?: * |
|
| *Does your dog act afraid of any specific item or noises? If so, please explain: * |
|
| Has your dog ever growled at someone? If so, please explain: |
|
| When was the last time your dog bit someone? What were the circumstances?: * |
|
| Does your dog have any problems with barking, jumping, house training, digging? If so, please explain: * |
|
| How does your dog behave when you try to take food or a toy away from him/her?: * |
|
| Does your dog play with toys? If so, what kind of toys?: |
|
| Has your dog been socialized around people and or other dogs? Please explain: |
|
| Has your dog had any formal obedience training? If so, when and where?: * |
|
| To what commands does your dog respond?: * |
|
| Do you consider your dog to be dominant or submissive?: * |
|
| Other comments about your dog that you feel might be helpful for us to know?: |
|
| |
