Canine Camper's
Name: |
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Camper's Parents'
Name: |
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| Camper's parents' address: |
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| Home phone: |
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Cell phone: |
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| Work phone: |
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Email address: |
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| Employer: |
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| Emergency Contact (Other than parent): |
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| Emergency Contact's phone number: |
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| Pet's Date of Birth: |
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Weight in pounds: |
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| Pet's sex: |
Male
Female |
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| Breed: |
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Color: |
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| Are there additional pets in household? |
Yes
No
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| If yes, please list: |
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| My camper is spayed or neutered (Spay and neuter is required at 6 months and older): |
Yes
No
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| My camper is microchipped: |
Yes
No
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| Are you interested in information about microchipping your pet? |
Yes
No
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| Veterinarian name: |
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Phone: |
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| Proof of vaccinations including rabies, DHLPP, and bordatella, must be submitted prior to coming to camp.
Please fax copies to 704-631-4554. |
| Please list your camper's special medical needs, or any known allergies: |
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| Other than a spay or neuter operation has your dog ever had surgery? |
Yes
No
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| If yes, please explain: |
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| Is your dog on a monthly flea preventative? |
Yes
No
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| What was the date of the last application? |
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| All campers are required to be on a monthly flea preventative. Dogs are checked for fleas upon entering Camp Bark. If your dog has fleas he/she will be treated at owner’s expense. |
Canine Behavior Questions
Please answer all questions as accurately as possible. |
| Is there ANY person, dog, or situation that your dog has ever had a problem with? |
Yes
No
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| Please describe: |
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| When traveling, does your dog get car sick? |
Yes
No
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| How long have you had your dog? |
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| Where did you get your dog? |
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| Has your dog ever growled or bitten another person or dog? |
Yes
No
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| If yes, please describe the circumstances: |
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| Has your dog ever been in a fight with another dog? |
Yes
No
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| Can you take away a food or toy item from your dog without him growling? |
Yes
No
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| Will your dog readily share toys with other dogs? |
Yes
No
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| Is there an area on your dog’s body where it does not like being touched by humans? |
Yes
No
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| If yes, what area? |
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| Does your dog have separation anxiety when left alone? |
Yes
No
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| Has your dog ever been destructive in the house? |
Yes
No
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| Has your dog ever destroyed bedding, like dog beds? |
Yes
No |
| When you are gone where does your dog stay? |
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| Has your dog ever been known to jump a fence or break out of a kennel? |
Yes
No
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| Has your dog ever socialized with a large group of dogs? |
Yes
No
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| Are there any restrictions that should be placed on your dog? |
Yes
No
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| If yes, please explain: |
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| Any other behaviors or habits that we should know about regarding our future camper? |
Yes
No
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| If yes, please explain: |
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| Is your dog frightened of loud noises or nervous during thunderstorms? |
Yes
No
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| Has your dog ever been formally obedience trained? |
Yes
No
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| What commands does your dog know? |
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| Does your dog have a bathroom command? |
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| How did you hear about Camp Bark? |
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Flyer
Newspaper
Drive by
Vet
Other
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| Referral Name: |
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| Have you ever used doggie day care or boarding services? |
Yes
No
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| What is your primary reason for bringing your dog to Camp Bark? |
| Travel Extensively:
Loves other Dogs:
Works long hours
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| Don't like to leave alone all day
Other
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| Which type of additional services would interest you? |
| Doggie Boot Camp/Training:
Grooming:
Special Events:
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| Doggie Day Camp:
Volunteering for local rescue groups:
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| Sponsoring a rescue dog
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| Please refer to our policies page for drop off and pick up times, and to the what to pack for camp page for important details. |
| Before clicking submit, please enter your initials here to indicate your acceptance of our terms: |
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LEGAL DISCLAIMER:
As the owner of the above referenced dog. I understand that Camp Bark, its employees, directors and agents, will exercise due care to protect the health and safety of my dog while in their care, and in the event that my dog becomes ill or sustains injury, I have given permission for those in charge to take whatever steps necessary to obtain medical treatment for my dog, and I agree to pay all charges incurred. I consent to any veterinarian being retained to render care for my dog. I understand the concept of doggie day camp is to allow dogs to socialize by interacting with people and dogs. As always, with the interaction of dogs, there is a chance of injury. I assume all risk of injury to my dog while at Camp Bark or in transportation so long as reasonable care is taken to prevent an unnecessary injury, illness or death, or loss of my dog. |
