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Residential Care for your Dogs-                   Application Form

Please complete and return to the office with your £10 non refundable arrangement fee.

 

Your Name:

 

 

Address:

 

 

 

Email address:

 

Daytime tel no:                         Evening tel no:                                     Mobile:

 

Emergency contact no:

 

 

Dogs name:                                                                             Age:

 

 

Breed:                          Male/ Female                                       Neutered:  Yes/ No

 

 

Date of Last Season (if applicable)

 

 

Details of Dog insurance company:

(please note we need to see a copy of the policy- please send this with your application)

           

Vets details:                

 

 

 

Current vaccinations    next due date:

(please note we need to see the vaccination card- please send a copy of this with the application form)

How long have you had your dog?

 

 

Please give a brief history - health/experiences etc.

 

 

 

 

Any health problems currently experiencing - please detail

 

 

 

 

 

What is the dog fed on? ( please be precise with quantities etc.)                       

 

 

 

 

When is the dog fed?  (please also give details of where and if any other animals are fed at the same time)

 

 

 

Is the dog on any medication - please list and for what reason?

 

 

Where does the dog sleep  -  (i)          daytime?

 

                                                (ii)        at night time?

 

Does the dog travel well? 

(If not please detail)

 

 

 

Is the dog with children at all?          Yes/ No

(If yes, please give children’s ages)

 

 

 

Are there any problems with children or any other animals?

(If yes, please give details?)

 

 

 

Is the dog clean in the house? (If not please give details.)

 

 

 

Are there any other pets in the household?                                        Yes/ No

(If yes, please give details?)

 

 

Has the dog attended training classes?                                               Yes/ No

(If yes, please give details?)

 

 

 

Do you have any specific training requirements to be addressed when your dog is staying with us?

 

 

Is the dog noisy?         Yes/No            

 

 

How long do you leave your dog alone at home?

 

Any problems?

 

 

Does it bark a lot when left?    Yes/No

 

 

 

Is the dog destructive when left?

 

 

 

 

 

Has the dog ever bitten? (Even in play? - this may not preclude the dog from going to a home, but we must know everything about your dog before we place him/her)

 

 

Are there any other details we need to know before we meet the dog - please give details.

 

 

 

Please note that by applying for your dog to be accepted for Residential Care you accept full responsibility for your dog and agree that all damage will be paid for by yourselves. All Veterinary treatment will also be paid for by yourself and that you agree we should contact your Vet in an emergency.  Naturally full precautions are taken at all times, but we are dealing with dogs!

 

 

 

Signed:                                                                                    Date:

 

 

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Last modified: October 18, 2011