OWNERS INFORMATION

 Name:____________________________________________________________________________________________________________________________

 Address:_____________________________________________________________City:________________________________St:__________Zip:__________

 Home Phone:________________________________________________Cell:___________________________________________________________________

 Work Phone:________________________________________________E-mail:_________________________________________________________________

 Emergency contact:__________________________________________Phone:__________________________________________________________________

 Vet Clinic:____________________________________Phone:________________________________________________________________________________

 How did you hear about us?   Phone book     vet     friend     newspaper ad

 
 PET PROFILE 

 Name:_______________________________________________________Nickname:_____________________________________________________________

 Breed:_______________________________________________________Color:________________________________________________________________

 Sex: M Neutered/  F Spayed   Age:_______________Birthdate:______________________________________________________________________________

 
 Any issues from the past that we should know about your dog? (if adopted, puppy years, etc…)

 __________________________________________________________________________________________________________________________________ 

 Medications:_________________________________________________________Reason for use:__________________________________________________

 Dosage and times per day:____________________________________________________________________________________________________________

 Flea and Tick control: (this is highly recommended)________________________________________________________________________________________

 Brand of food, amount and times per day:________________________________________________________________________________________________

 Has your dog visited another day care, kennel, dog park, if so how do they react?

 How is your dog with children?_________________________________________________________________________________________________________

 How is your dog with other dogs?_______________________________________________________________________________________________________

 Is your dog food or toy possessive? (growl, nip)___________________________________________________________________________________________   

 Is your dog sight or sound sensitive?____________________________________________________________________________________________________

 Is your dog an escape artist? (climb fences, squeeze out of things):___________________________________________________________________________

 Please provide any other information that you think will be helpful:____________________________________________________________________________

 Remember to please bring a copy of current vaccinations: Rabies, DHLPP, Bordatella

Crawfish Corners LLC t N4936 Popp Rd t Jefferson, WI 53549 t (920) 674-5517