THE DOG CLUB OF FORT COLLINS

Daycare Information Sheet

Date:_________________

Owner’s Name:____________________________________________________

Street:___________________________________________City:_________________Zip Code:___________

Email Address (for newsletter) ________________________________________________________________

Telephone:  Home:____________________ Work:_______________________Cell:______________________

How did you hear about The Dog Club?  _____Friend   ______Dex  ______Yellow Book  ______Newspaper

            _______Radio   ______Event Booth   ______Other (describe) _______________________________

Emergency Contact:  Name:___________________________________Phone:___________________________

Veterinarian Name & Phone Number:___________________________________________________________

Dog’s Name:_____________________________________Breed:_____________________________________

Dog’s Age:______________ Dog’s Birthday____________________Sex:_________________

Is your dog spayed or neutered? _________________

Medical Conditions:_________________________________________________________________________
Medications:_______________________________________________________________________________
If we are to administer medications, please bring them in a sealed container, clearly marked with your dog’s
name, dosage and time to be administered.

Is your dog fearful?   Y/N  Is your dog fearful of dogs:____;  men____;  women____; children____; other____?
Please describe the circumstances surrounding the fearful behavior:____________________________________
__________________________________________________________________________________________

Is your dog aggressive?   Y/N  Is your dog aggressive towards dogs_____; men_____; women_____; 
children_____; food_____; other_____(please describe)____________________________________?
Please describe the circumstances surrounding the aggressive behavior:_________________________________
__________________________________________________________________________________________

Does your dog let you?? (Y/N)  clip his nails_____;brush him_____;put your hand in his food bowl_____;
take away his toys/bones_______.

My dog growls when_________________________________________________________________________
My dog bites when__________________________________________________________________________

Is your dog allowed the following (Y/N)?  rawhide_____; pig ears_____; bully sticks _____; tennis balls_____;  
tug robes_____;  other restrictions______________________________________________________________?

Does your dog jump fences or other enclosures?___________________________________________________

Additional things we should know?_____________________________________________________________
_________________________________________________________________________________________