First Name:
Last Name:
Dog's Name:
Breed:
Age: years months weeks
Sex: Neutered Male Spayed Female Intact Male Intact Female
List any Medical Problems, allergies, etc:
List any temperament issues:
Is your dog used to a crate? Yes No
Does your dog have separation anxiety issues? Yes No
Has your dog ever escaped from a fence? Yes No
Does your dog get along well with other dogs/puppies? Yes No I Don't Know
Has your dog ever attended daycare? Yes No
Address:
City / State / Zip:
Phone (cell):
Phone (day):
Phone (eve):
Emergency Contact Name:
Emergency Contact Phone:
Email:
Is your dog current on the following vaccinations?
Rabies (age appropriate)
Parvovirus
Distemper
Parainfluenza
Bordetella (Kennel Cough) - within past 6 months
Choose One: Yes No Not Sure
Has your pet been spayed or neutered?
Choose One: Yes No
Has your pet received previous training (either at our facility or another)?
Please list any behavior issues that you would like to focus on:
How were you referred to Swanson's Streamway Dog Park and Daycare?
Name of Veterinarian / Clinic:
Veterinarian / Clinic Phone Number:
Important: Please remember to bring with you a copy of your dog's current vaccination record to your first class. This is required to participate in any class at Swanson's Streamway Dog Park and Daycare.
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