If you have more than one dog in your family, please fill out all fields for the first dog, and fill out a new form for each additional dog. You ONLY need to fill out fields marked with (*) for the additional dog(s).
If you chose "friend" or "vet referral" please tell us who...
*Your last name
Cell Phone
If an emergency were to occur, we would contact you first. But if you are traveling out of town or you cannot be immediately reached, please provide us with an.... EMERGENCY CONTACT NAME ...and that person's EMERGENCY CONTACT PHONE NUMBER
Street Address Zip code
*Dog's Name
*Is your dog spayed/neutered? YES NO
*Dog's Color/Markings
*Is your dog used to being around/playing with other dogs? YES NO
*Does you dog regularly take medication? YES NO If you answered "yes," what medications and why? Please explain...
*Is your dog fearful of certain noises or people? YES NO If you answered "yes," please explain. ie: thunder, the vacuum, people wearing hats, etc...
*Has your dog ever escaped from your home of another dog facility? YES NO If you answered "yes," how did/does your dog escape? And can your dog jump a 6 foot or an 8.5 foot fence? Please explain...
Please use the field below if there is there anything else you would like to tell us about your dog's personality or history...
Clicking "I Agree" indicates that you have read and agree to abide by all the rules, terms, and conditions set fourth above - This will send your information to us automatically.