Work Phone *
Work Phone
Cell Phone *
Cell Phone
Address *
Address
Pet Birthday
Pet Birthday
Medical Info
*
Is your dog currently on heartworm preventative?
*
Is your dog currently up to date on all standard vaccinations (rabies, distemper, lyme)?
*
Is your dog currently on a flea and tick preventative medication?
Veterinarian Phone *
Veterinarian Phone
In the event of a medical emergency, every attempt will be made to contact you or your emergency contact for further instruction. In the event that you cannot be contacted, does Canine Adventure have your permission to seek emergency medical treatment for your dog at your cost? *
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Behavioral Info
The following questions will help Canine Adventure handle your dog properly. Please answer as truthfully as possible. Normal behavior issues will not preclude your dog's participation, but knowing about them will allow Canine Adventure to better meet your dog's needs.
Does your dog... *
ride nicely in the car?
*
have any professional obedience training?
*
sit on command?
*
obey the command 'stay'?
*
obey the command 'come'?
*
walk nicely on a leash?
*
walk nicely off leash?
*
show any signs of human or canine aggression?
Please read the statements below and initial to indicate your full understanding and agreement.
Please initial below
Please initial below
Please initial below
Please initial below
Please initial below
Canine Adventure will handle your dog responsibly and according to your instructions. You may decline to agree to the following statements by simply not initialing.
Please initial below
Please initial below
Please initial below
Please initial below
CERTIFICATION STATEMENT
Please write full name as an electronic signature followed by date