Wag Doggie Day Care Client Form - Wag The Dog Daycare
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2Wag The Dog Daycare Client Form
Parents Name: ________________________________________________________________________________________________________
Address: ______________________________________________________________________________________________________________
City: ______________________________________________________ State: __________________________ Zip: _____________________
Home Phone: __________________________ Work Phone: __________________________ Cell Phone: ___________________________
Other household member phones: _____________________________________________________________________________________
E-mail address:
_______________________________________________________________
This is the most efficient way to notify everyone about shots, upcoming events or important messages.
(Persons outside of your
home)
*****!!!
Emergency Contacts
*****!!!
*****!!!
You
will always be our
first
contact, this is if we cannot reach you
*****!!!
Name 1: _________________________________________________
Name 2: _____________________________________________
Phone: (H) ______________________ (W) ____________________
Phone: (H) ______________________ (W) ________________
Cell Phone: _______________________________________________
Cell Phone: ___________________________________________
Who is your Vet:
Name/Clinic:
Phone:
___________________________________________________
__________________________
Your Dog’s Name: ____________________________________ Breed: ___________________________ Birthday: ____________________
........................................................................................................................
☐
☐
Is your dog spayed or neutered?
Yes
No
List any allergies your dog has: _________________________________________________________________________________________
What kind of flea treatment is used on your dog? _______________________________________________________________________
.................................................................................................................
☐
☐
Does your dog jump or climb fences?
Yes
No
Special Instructions / Is there anything else we need to know about your dog?
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
☐
☐
☐
Which services are you interested in utilizing?
Daycare
Boarding
Grooming
Where did you hear about us?
☐
Friend _________________________
☐
Google
☐
Yelp
☐
DexOnline Internet
☐
Facebook
☐
Phone Book
☐
☐
☐
Festival / Street Fair
Drive By
Other _________________________________________________________________
As owner of the above said pet, I hereby give consent for emergency medical care as prescribed by a duly licensed
veterinarian. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my pet.
Signature:
_________________________________________________ Date: ___________________________
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