Day-Camp Intake Form Name * First Name Last Name Email * Phone * (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Pets Information Dog Name Breed Birthdate MM DD YYYY Sex * Male Female Neutered Male Spayed Female Current Weight * Where did you get them * Breeder Rescue Friend Marketplace ( Such as facebook or craigslist) Other Medical History Is your dog current on the following vaccinations: * DAPP (Distemper, adenovirus, Parvo, Parainfluenza), Leptospirosis, Rabies, Bordetella Is your dog current on flea/tick/heartworm prevention ? * If yes please provide what you given them and the date of the last dose Has your dog had a fecal parasite exam in the last 30 days * A fecal exam is required within 30 days of their first visit Does your dog have any current or prior medical conditions If so please list all below and if they are on medication for them Does your dog have any food allergies? Training Basics Is your dog current on their Rabies vaccine Yes No Not old enough Is your dog house trained Potty Trained Yes No Mostly Litterbox or Potty Pad Trained Is your dog crate trained No Yes can be left alone for 8+ hours Yes can be left alone for 4+ hours Mostly can be left alone for <2 hours Have you used another trainer or company in the past? If yes, Please provide the name of the trainer or company What training methods have you used Food Rewards Verbal Praise Shock Collar/ E-Collar Prong Collar Physical Corrections Verbal Corrections None Yet Has your dog ever bitten anyone No Yes a family member Yes a friend Yes a stranger How does your dog do with other dogs What does their play look like? How does your dog do with small animals ( Cats, squirrels, birds) This is mainly concerning cats, if they have not had interactions with cats then how they do with other small animals can be useful info. Has your dog ever attended a doggy-daycare or puppy social? * If yes, what one(s) and how did they do? Behavior Have there been any incidents of concern with family members/friends/strangers Any grumbles, growls, snaps, odd behavior or someone your dog just does not seem to like? Is there anything your dog is afraid of ? Is there anything your dog LOVES Are there any specific days/times you are looking to utilize this service? This service is primarily offered on Tuesdays but can be accommodated on other days based on availability Additional Info Why would you like to enroll them in Day-Camp? * Is there anything else you would like me to know prior to the initial evaluation Is there a day of the week or time that would work best for you to bring your dog for a brief trial day * This is to make sure they will be a good fit for my home and for the Day-camp group Are there any household allergies I should be aware of In the cases of allergies or conditions such as Celiac, or I am happy to ensure your pet is not given any treats or other items that may trigger a reaction for someone once they return home. As well as ensure that I do not bring treats with me that include any listed allergens. How did you hear about us? Thank you!