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