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Amherst St.
Harlem Rd.
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Menu
Daycare
Amherst St.
Harlem Rd.
Grooming
Training
Our Trainers
Training Schedule
Pet Sitting & Transport
Gallery
About
Employment
News & Announcements
Contact
PetExec Login
All information provided for this questionnaire will be kept strictly confidential.
Step
1
of
5
20%
Registration/Background Information
Location You Plan On Attending
Amherst St.
Harlem Rd.
Both Locations
Primary Owner's Name
*
First
Last
Additional Owner's Name
*
First
Last
Your Pet's Name
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Owner's Cell Phone Number
*
Additional Owner's Cell Phone Number
*
Primary Owner's Home Phone Number
*
Email – Primary
*
Emergency Contact Name – Should not be Owners listed above
*
Emergency Contact Number – Should not be Owners listed above
*
Name of Any Other Person Authorized to Pick Up or Drop Off Your Dog (Photo ID Required)
*
Upload Photo ID
Max. file size: 50 MB.
Dog's Background Information
Dog's Date of Birth
*
MM slash DD slash YYYY
Dog's Gender
*
Has your dog been spayed or neutered?
*
Yes
No
How Long Have You Owned Dog?
*
Dog's Weight
*
Dog's Breed
*
Dog's Color
*
Is your dog housebroken?
*
Yes
No
Behavioral Information
Has your dog been crate-trained?
*
Yes
No
Not Sure
Has your dog ever had any informal or formal training?
*
Yes
No
Not Sure
Has your dog ever exhibited any aggressive behavior toward other dogs?
*
Yes
No
Not Sure
Has your dog ever bitten a person or another dog?
*
Yes
No
Not Sure
Has your dog ever been bitten by or attacked by another dog?
*
Yes
No
Not Sure
Please tell us about any previous socialization experience your dog has; for example, daycare, playgroups, or the dog park
*
Please tell us what you can about any unfavorable incidents involving other dogs.
*
Does your dog have any fears we should know about, such as bare floors, steps, or separation anxiety?
*
Does your dog exhibit any of these chronic behaviors? (Select all that apply)
*
Jumper
Chewer
Escape Artist
Barker
None of the Above
Please provide details about your dog's chronic behaviors.
Medical Information
Veterinarian/Clinic Name
*
Veterinarian/Clinic Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Veterinarian/Clinic Phone Number
*
What flea prevention method do you use?
*
What heartworm prevention method do you use?
*
Does your dog have any allergies or other medical conditions we should be aware of?
*
Yes
No
Not Sure
Please list your dog's allergies or medical conditions.
Are there any other special needs or instructions regarding your dog's care that we should be aware of?
*
Yes
No
Not Sure
Please list any needs or instructions here.
Has your dog received a rabies vaccination?
*
Yes
No
Not Sure
Additional Information
Desired Services
*
Daycare
Grooming
Group Training
Other
Do you have any questions or concerns?
How did you hear about us?
*
Would you like to receive special offers and announcements from us?
Yes
No