Boarding Application
Instructions : If you have more than one dog, each dog will need a separate form.
You do not, however, need to repeat the information about yourself.
Parent Information
Name ___________________________________________________________________
Address _________________________________________________________________
City ______________________ Province/State ________________________
Postal Code/Zip ___________________________________________________________
Home Phone _________________ Emergency Phone ____________________________
Work Phone _________________ Cell Phone/Pager ____________________________
Email ___________________________________________________________________
Who else is authorized to drop off/pick up the dog (s)? ___________________________
_________________________________________________________________________
Instructions in Case of Emergency ___________________________________________
_______________________________________________________________________
How did you hear about us? ________________________________________________
Your Dog's Information
Name ________________ Breed _______________________ Age _________
Sex : Male/Female Spayed/Neutered : Yes/No*
* If Female Unspayed, Date of Last Cycle _____________________________________
Weight _____________ Colour _____________________________________________
How does your dog get along with other dogs? _________________________________
People? __________________________________________________________________
Has your dog used any daycare/boarding facility before? Yes*/No
*If yes, where? ____________________________________________________________
Has your dog ever bitten another person or dog?______________
If so, please describe the circumstances:_______________________
_________________________________________________
Can you take a food-based item away from your dog without him growling?
______________________
Will your dog readily share toys with other dogs?
______________________
Has your dog ever jumped a 6' high fence?
______________________
Your Dog's Health
Veterinarian/Clinic ________________________________________________________
_________________________________________________________________________
Address _________________________________________________________________
Phone Number ___________________________________________________________
Please describe your pet's general health (include current medical conditions)
_________________________________________________________________________
_________________________________________________________________________
Allergies (if any) __________________________________________________________
_________________________________________________________________________
Current Medications ______________________________________________________
Frequency & Time Administered ____________________________________________
What Flea & Tick Prevention Treatment is Used? ______________________________
_________________________________________________________________________
**Vaccination Record - Please attach a copy from your vet's office.**
Your Dog's Routine
Wake-up Time _______________________________________________
Regular Food : Brand _______________________ Feed Times ___________________
Quantity ____________ Instruction _________________________________________
Exercise/Walk _____________________________ Times ____________________
Favorite Activities/Toys/Buzz Words _________________________________________
_________________________________________________________________________
Items Brought/Luggage ____________________________________________________
_________________________________________________________________________
Agreement
I certify that I am the owner or agent of the owner of the aforementioned dog,and that
I am authorized to board the dog and sign this form. I authorize Mountain Dog Lodge
to contact my veterinarian in order to confirm health, temperament, and vaccinations.
I give consent to Mountain Dog Lodge to act on my behalf by obtaining veterinary care
at my expense, should Mountain Dog Lodge deem it necessary. I have read the schedule
of fees and agreed to pay all charges at checkout, unless previously arranged. I release
Mountain Dog Lodge (and its agents and employees) from any liability or claim due to
injury or death of my dog, unless Mountain Dog Lodge has been negligent in the care of
my dog. I understand that under no circumstances will Mountain Dog Lodge be liable
for consequential damages or demands beyond the replacement value of my dog.
Finally, I realize Mountain Dog Lodge is not your typical boarding facility in that they are offering a special “like home” service for special dogs. I certify that I know my dog and his/her behaviours and that any destruction of the Lodge and its property (chewing through walls/doors, destroying pillows/blankets/beds) caused by my dog is my responsibility and I will be responsible for the replacement cost of such damage.
Signed ____________________________ Date ___________________
**Uncancelled Reservations MUST Be Paid In Full**
Thank you!!
