Canine Camper's
Name: |
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Camper's Parents'
Name: |
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| Camper's parents'
address: |
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| Home phone: |
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Cell phone: |
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| Work phone: |
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Email address: |
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| Employer: |
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| Emergency Contact (Other than
parent): |
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| Emergency Contact's phone number: |
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| Pet's Date of Birth: |
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Weight in pounds: |
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| Pet's sex: |
Male
Female |
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| Breed: |
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Color: |
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| My camper is spayed or neutered
(Spay and neuter is required at 6 months and older): |
Yes
No
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| My camper is microchipped: |
Yes
No
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| Are you interested in information
about microchipping your pet? |
Yes
No
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| Veterinarian name: |
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Phone: |
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| Please list your camper's special
medical needs, or any known allergies:: |
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| Other than a spay or neuter
operation has your dog ever had surgery? |
Yes
No
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| If yes, please explain: |
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| Is your dog on a monthly flea
preventative? |
Yes
No
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| What was the date of the last
application? |
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| All
campers are required to be on a monthly flea preventative. Dogs are
checked for fleas upon entering Camp Bark. If your dog has fleas
he/she will be treated at owner’s expense. |
Canine
Behavior Questions
Please answer all questions as accurately as possible. |
| Is there ANY person, dog, or
situation that your dog has ever had a problem with? |
Yes
No
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| Please describe: |
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| When traveling, does your dog get
car sick? |
Yes
No
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| How long have you had your dog? |
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| Where did you get your dog? |
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| Has your dog ever growled or bitten
another person or dog? |
Yes
No
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| If yes, please describe the
circumstances: |
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| Has your dog ever been in a fight
with another dog? |
Yes
No
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| Is there an area on your dog’s body
where it does not like being touched by humans? |
Yes
No
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| If yes, what area? |
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| Does your dog have separation
anxiety when left alone? |
Yes
No
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| Has your dog ever been destructive
in the house? |
Yes
No
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| Has your dog ever destroyed bedding,
like dog beds? |
Yes
No |
| When you are gone where does your
dog stay? |
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| Has your dog ever been known to jump
a fence or break out of a kennel? |
Yes
No
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| Has your dog ever socialized with a
large group of dogs? |
Yes
No
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| Are there any restrictions that
should be placed on your dog? |
Yes
No
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| If yes, please explain: |
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| Any other behaviors or habits that
we should know about regarding our future camper? |
Yes
No
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| If yes, please explain: |
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| Is your dog frightened of loud
noises or nervous during thunderstorms? |
Yes
No
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| What commands does your dog know? |
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| How did you hear about Camp Bark? |
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Flyer
Newspaper
Drive by
Vet
Other
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| Referral Name: |
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| Have you ever used doggie day care
or boarding services? |
Yes
No
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| What is your primary reason for
bringing your dog to Camp Bark? |
| Travel Extensively:
Loves other Dogs:
Works long hours
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| Don't like to leave alone all day
Other
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| Which type of additional services
would interest you? |
| Doggie Boot Camp/Training:
Grooming:
Special Events:
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| Doggie Day Camp:
Volunteering for local rescue groups:
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| Sponsoring a rescue dog
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| Please refer to our
policies page for drop off and pick up times, and to the
what to pack for camp page for important details. |
| Before clicking
submit, please enter your initials here to indicate your acceptance
of our terms: |
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LEGAL
DISCLAIMER:
As the owner of the above referenced dog. I understand that
Camp Bark, its employees, directors and agents, will exercise due
care to protect the health and safety of my dog while in their care,
and in the event that my dog becomes ill or sustains injury, I have
given permission for those in charge to take whatever steps
necessary to obtain medical treatment for my dog, and I agree to pay
all charges incurred. I consent to any veterinarian being
retained to render care for my dog. I understand the concept
of doggie day camp is to allow dogs to socialize by interacting with
people and dogs. As always, with the interaction of dogs,
there is a chance of injury. I assume all risk of injury to my
dog while at Camp Bark or in transportation so long as reasonable
care is taken to prevent an unnecessary injury, illness or death, or
loss of my dog. |
