Daycare Enrollment Form printable pdf download

Daycare Enrollment Form

General Information:

Dog’s Name ________________________________

Parent(s) Name(s) (please list all participants) ______________________________________________

Address: ____________________________________________ City: ____________________

St: ______ Zip: ___________

Home Phone: _________________Work: ________________Cell: _______________

Email Address: _____________________________________

(by supplying this, you agree to receive periodic emails from TDA)

Breed: _______________________ Age: _________ Color: ________________ Weight: __________

Sex: ! M ale

! F emale

! A ltered

Vet Clinic: _____________________________________

Emergency Contact

):______________________________Phone:______________

(other than yourself or spouse

Were you referred to us? ! Yes ! N o If yes, by whom? ___________________________________________

How often do you intend to utilize daycare?____________________________________

Vaccination/Medical History:

Rabies due:________________

DHLPP due:_________________

Bordetella due:________________

Describe any medical/health issues we need to be aware of (i.e. seizures, heart/hip problems, etc.): ____________________

What type of flea/tick preventative are you using? ______________________ How often is it applied?___________

Has your dog been diagnosed with anything contagious within the past 6 months? Yes No

If yes, what? ___________________________ How long ago was your dog treated? ____________

Dog Profile:

Has your dog ever been enrolled in daycare before? ! Yes ! No If yes, where? ______________________________

How long has your dog been in your family? _________ Was your dog adopted from a shelter/rescue? ☐Yes ☐No

Does your dog display any anxiety/aggression towards other dogs? _____ People? _____ Children? _____ Cats? _____

Have you and your dog participated in any kind of formal obedience training? ________

If yes, where and when? ___________________

Is your dog comfortable having his/her feet touched? ______ Is your dog comfortable with being lead by his/her collar?______

Does your dog guard food, toys or bones? _____ Has your dog ever climbed a fence? _____ Does your dog like to dig

holes?_____ Does your dog play with other dogs on a regular basis? _____ Does your dog dislike any certain types of dogs,

puppies or people? _____ If yes, explain:___________________________________________________

Describe any behavioral problems/idiosyncrasies/special sensitivities we should be aware of:________________________

____________________________________________________________________________

PLEASE NOTIFY US IMMEDIATELY IF ANY OF THE ABOVE INFORMATION CHANGES.

2139 Wilson Farm Lane  Greenville, NC, 27858  (252) 752-8215 

Daycare Enrollment Form