Welcome To Reggie's Pet LYvers

you are here: Online Application >

 

The following agreement and application form you must read over carefully and sign to become a member at the daycare.

Reggie's Pet LYvers Doggie Daycare Application Form
Just fill out the form below and click "Send". We will get back to you ASAP!  Or click here if you want print and hand write it out and drop it off at the shop.

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Name of Parent(s):

Home Phone:

Work Phone:

Alternative phone:

Email Address:

Would you like us to contact you to set up a day and time for your dog to come in?

yes no

How would you prefer we contact you?

What's the best time to call?

 

Street Address:

City:

Postal Code:

Veterinarian's name:

Veterinarian's phone:

Whom to contact in an emergency:

phone number :

Where did you hear about our Doggy Daycare:

If referred by a customer, what is their name?

Who is authorized to pick your dog up?

First Dog Information

 

Name of Dog:

Breed:

Sex:

Spayed or Neutered:

yes   No

*If not spayed or neutered over 6 months, we will not accept in daycare

Birthday:

Age:

Known Commands:

Please indicate any allergies/medical conditions:

Favorite playtime activities:

Can we give your dog treats?

yes   no

Do you need us to administer medicine, if so please explain :

Has your dog ever shown aggression toward humans or dog(s) in certain situations?

yes   no

Does your dog get along with all dogs?

yes   no

If not, please explain: (i.e. smaller dogs)

Other information:

Name of Parent(s):

Name of Dog(s):

Home Phone:

Work Phone:

Alternative phone:

Email Address:

 

 

(Optional) Second Dog Information

 Only fill out the below information if more than 2 dogs.

Name of Dog:

Breed:

Sex:

Spayed or Neutered:

yes   No

*If not spayed or neutered over 6 months, we will not accept in daycare

Birthday:

Age:

Known Commands:

Please indicate any allergies/medical conditions:

Favorite playtime activities:

Can we give your dog treats?

yes   no

Do you need us to administer medicine, if so please explain :

Has your dog ever shown aggression toward humans or dog(s) in certain situations?

yes   no

Does your dog get along with all dogs?

yes   no

If not, please explain: (i.e. smaller dogs)

Other information:

 


   
©Copyright 2006, 2007 Reggie's Pet Lovers
 
Last modified: 11/28/07