Canine Daycare Application – Vale Park Animal Hospital

Owner Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Primary Phone Type*

Cell Phone
Landline Phone

Emergency Contact (someone not traveling with you)

Name*

First Last

Email*

Relation*

Phone Number*

Pet Profile

Name*

Gender*

Male
Female

Breed*

Weight*

Age*

Colors & Markings*

Is your dog spayed or neutered?*

Yes
No

Medical Information

Is your dog a patient at Vale Park Animal Hospital?

Yes
No

Veterinarian*

City*

Phone*

Is your dog on any medications? Please List:

Medication	Directions

Vaccination Info

Owner must provide proof of current / updated Rabies, Distemper/Parvo (DH2PP) and Bordetella in accordance with our vaccination requirements.

Vaccination Records Upload

If your pet is not a current patient at Vale Park Animal Hospital, please upload a digital copy of their current vaccination records here.

Additional Information & Services

How did you hear about The Lodge?*

Has your dog every been in daycare before?*

Yes
No

Where did your dog have daycare previously?*

Which days of the week will you be requesting daycare services?*

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Are you interested in using The Lodge for boarding services? (must schedule at least 48 hours in advance)?*

Yes
No

What food does your pet eat?*

How much/often do you feed?*

Additional Behavioral Information

Where did you get your dog?

How long have you had your dog?

Does your dog get along with other resident animals, if you have any?

Yes
No

Please explain.

Has your dog successfully shared food, water, or toys with other animals?

Yes
No

Please explain.

Is there any person, dog, or situation that makes your dog uncomfortable?

Yes
No

Please explain.

Can you take food, treats, or toys away from your dog without them growling or showing their teeth?

Yes
No

Has your dog ever growled at or bitten another person or dog?

Yes
No

Please explain.

Does your dog have any areas where they do not like to be touched by humans?

Yes
No

Please explain.

Has your dog ever climbed / jumped a fence?

Yes
No

How high was the fence?

Has your dog ever socialized off-leash with a large group of dogs (15+)?

Yes
No

Where?

Are there any restrictions on your dog's activities?

Yes
No

Where?

Please explain.

Canine Boarding Application

Owner Information

Emergency Contact (someone not traveling with you)

Pet Profile

Medical Information

Vaccination Info

Additional Information & Services

Additional Behavioral Information

Vale Park Animal Hospital

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