Daycare Application

Please fill out the form in its entirety.

Your Information
Name * First Last
Phone Number * - ### - ### ####
Spouse Name First Last
Spouse Phone Number - ### - ### ####
Email Address *
Address: *
Emergency Contact * First Last
Emergency Contact Phone * - ### - ### ####
About your Pet
Name *
Breed *
Weight *
Age *
Birthdate
Is your dog spayed/neutered? *

Is your dog spayed/neutered? Yes No
Vet
Vet Phone - ### - ### ####
Would you like us to notify your Vet in the case of an emergency? *

Would you like us to notify your Vet in the case of an emergency? Yes No
Is your dog on any flea or tick prevention? *

Is your dog on any flea or tick prevention? Yes No
Is your dog on heartworm prevention? *

Is your dog on heartworm prevention? Yes No
Is your dog good with other dogs? *

Is your dog good with other dogs? Yes No
Has your dog ever bitten a person? *

Has your dog ever bitten a person? Yes No
Has your dog ever attacked or bitten another animal? *

Has your dog ever attacked or bitten another animal? Yes No
Is there any PERSON, type of DOG, or SITUATION your dog seems uncomfortable with? Yes No (i.e., children, men, hats. . . ) *

Is there any PERSON, type of DOG, or SITUATION your dog seems uncomfortable with? Yes No (i.e., children, men, hats. . . ) Yes No
Is your dog cat friendly? *

Is your dog cat friendly? Yes No Unknown
Has your dog ever shown any sign(s) of food aggression? *

Has your dog ever shown any sign(s) of food aggression? Yes No
Has your dog ever shown any sign(s) of toy aggression? *

Has your dog ever shown any sign(s) of toy aggression? Yes No
Is your dog 100% potty trained? *

Is your dog 100% potty trained? Yes No
Are there any housetraining or household issues in which you would like us to be aware? (i.e., chewing, potty training, separation anxiety. . .) *

Are there any housetraining or household issues in which you would like us to be aware? (i.e., chewing, potty training, separation anxiety. . .) Yes No
If yes, please explain in detail
Is your dog crate trained? *

Is your dog crate trained? Yes No
Have you ever noticed obsessive behavior when your dog plays with his favorite toy(s)? *
Yes No
Where does your dog sleep, at home? *
How often is your dog around other dogs outside of the home? *
What is your dog's favorite toy? (i.e, ball, rope, squeeky, plush) *
Are there any places your dog does not like to be touched? *
How old, and under what circumstances, did you adopt your dog? *
Does your dog have issues with enclosures or being alone in a room? *

Does your dog have issues with enclosures or being alone in a room? Yes No
Please provide any relevant background information, in which you are aware, such as history of abuse or lack of socialization before entering your care.
Has your dog participated in other forms of group play in the past? *

Has your dog participated in other forms of group play in the past? Yes No
If yes, where?
Have you ever had any cause for concern during group play? *

Have you ever had any cause for concern during group play? Yes No
Does your dog ever try to jump over or dig under your fence? *

Does your dog ever try to jump over or dig under your fence? Yes No
Does your pet have any special needs or illness? *

Does your pet have any special needs or illness? Yes No
If yes, please explain
Does your pet have any allergies? *

Does your pet have any allergies? Yes No
If yes, please explain
What brand of dog food does your dog eat? *
Amount
Times of Day
Is your dog on any medication? *

Is your dog on any medication? Yes No
If yes, please list, in full detail, the name of the medication(s) and dosage to be provided:
Amount
Times of day
Do you mind if your dog eats snacks at night (i.e., popcorn, pretzels, and carrots)? *

Do you mind if your dog eats snacks at night (i.e., popcorn, pretzels, and carrots)? Yes No
How did you hear about Lucky Puppy? *
I would like assistance with the following "problem" behaviors with my dog:
Are you interested in:
If Boarding only, approximately how often would you need your dog to vacation with us?

Daycare Application

Daycare Application

Your Information

About your Pet