Application for Enrollment

Owner Information
Owner Name
Address
City State Zip
Telephone Cell Work Phone
E-Mail
Employer

Dog Information
Name Breed
Age Birthdate M Neutered F Spayed
Vet's Name
Clinic
Address City
State Zip Telephone

How long have you owned your dog?
Where did you get your dog?
Where does your dog spend most of his/her time?
Current Vaccination Dates: Da2LP CPV
Corona Bordatella (must be current within 6 mos.)
Rabies Tag #
Method of flea control
Heartworm
Does your dog have any medical conditions such as allergies, skin problems, heart conditions, loss of hearing or eyesight? Please describe.

Does your dog require medications for such condition? Yes No
Is your dog groomed professionally? Yes No
Has your dog attended formal obedience classes? Yes No
Where
Of the following, please select all which your dog DOES NOT LIKE:
Other dogs Neighbors Veterinarian Cats Children Paperboy Birds Women Bikes Squirrels Men Cars Mailman Loud noises (Ctrl+click as you select)
Select all toys your dog enjoys playing with. Ball Rope Kong Squeaky toy Frisbee Fleece toy Tug toy Water hose/pool Other pets (Ctrl+click as you select)
Has your dog been known to jump a fence? Yes No
Has your dog ever bitten anyone? Yes No If yes, explain.

Has your dog ever bitten another animal? Yes No If yes, explain.

Is your dog protective or possessive of any of the following: (select all that apply) Family members Other pets Food bowl Toys House/yard Vehicle (Ctrl+click as you select)

How did you hear about Dog Day Afternoon, Inc. Doggie Dude Ranch?