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Canine Clubhouse Inc. A place to run, a place to play 7 Eastview Drive Suite B Farmington, CT 06032 (860) 673-9929 |
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Print the following form, then fax or bring them to the clubhouse! MEMBERSHIP APPLICATION Owner Information (Please print or type)Where did you hear about
us?________________________________________________ Address: ______________________________________ Work Phone: _________________ City/ST/Zip ____________________________________ Cell Phone: __________________ Email Address __________________________________ Employer ______________________________________ Work Phone: _________________ Emergency Contact: _____________________________________ Phone: ___________________ Does this person have the authority to make decisions if you cannot be reached? (Y) (N) Veterinarian: ________________________ Veterinary Hospital ____________________________ Veterinarian Phone: ________________ Vaccinations up to date? (Y) (N) May we check? (Y) (N) Pet Name(s): Breed Sex Birthday Color Spayed or Neutered: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Please list the name and phone of any person who will be authorized to drop off and pick up your pet? __________________________________________________________________________________ Signature ________________________________________ Date: ________________________
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Stay and Play Application - (One application per dog and please print)Dog First/Last Name: ______________________________ How long have they lived with you? _________ Where did you get them: Breeder Shelter Pet Store Stray Friend Other _______________________________ Does your dog have any current medical problems? ________________________________________________ Does your dog take any medication regularly? ____________________________________________________ Is your dog on any medication at this time? ______________________________________________________ Flea or Tick Prevention? _____________________________________________________________________ Does your dog have any physical limitations that will need our special attention or prevent certain types of play? _____________________________________________________________________________________ Can your dog have treats? _______ Does your dog have any
allergies to particular treats? _________________ Is there anywhere that your dog does not liked to be touched?________________________________________ Does your dog have any separation anxiety issues? ________________________________________________ Is your dog nervous of loud noises or thunder? ____________________________________________________ Does your dog mind going in a Vari-Kennel (plastic dog crate)? ___________________________________________ How does your dog normally stay at home? Cage Pen Enclosed Room Free run of house Other____________ Is your dog house trained? ___________________________________________________________________ How frequently do they need to go outside? _____________________________________________________ Will your dog only go to the bathroom in certain areas or on certain textures? ____________________________ What will your dog do to alert us they need to go out? _____________________________________________ Does your dog have a "word" to command them to go the bathroom? _________________________________ Has your dog ever attended a Daycare before? (Y) (N) Off Leash Dog Park?___________________________ How does your dog interact with Adults? ___________________ Children? _____________________ Other dogs? ________________________________ Puppies? ___________________________ Does your dog live with other animals in the household? ____If so what type?___________________________________ Which of the following activities does your dog like to play? Ball Frisbee Keep Away Tug o War Belly Rubs Cuddle Time Chase Me Lounge Around Climb and Jump Run and Play Hide n Seek What makes your dog happy?_________________________________________________________ What makes your dog angry?_________________________________________________________ Has your dog ever had a fight with another dog or a dog they live with? ______________________ Has your dog ever bitten someone?_____________________________________________________________ During a grooming?____________________________ During a nail clipping?___________________ Has your dog ever bitten another dog?__________________________________________________________ Is your dog possessive of Toys? ________________ Food?________________ Items?____________________ Has your dog ever growled, snarled or snapped at anyone while someone was taking something away?________________ Does your dog do any of the following? Barks excessively Destructive Chewing Digs Stool Eater Jumper Escape artist Disobey Commands House Training Issues Shyness Problems Pulls On Walks Jump Over Fences Mouthy Not liked to be touched Has your dog had any formal obedience training? __________________________________________ Where/When? ______________________________________________________________________ What method of training? _____________________________________________________________ What commands does your dog know?________________________________________________________ Does your dog like water?____________________________________________________________________ Has your dog ever been swimming before? _______________________________________________________ Thank you for taking the time to complete this packet of information. This will allow us to make sure that each dog has an enjoyable and safe experience while visiting us at Canine Clubhouse! Signature ___________________________ Print Name ______________________________ Date:____________________ Office Only: Evaluated _________ Initial ___________
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