Day Care Form

Owner Information:

Name:

Mr/Mrs

Address:

Postcode:

Mobile

Phone:

Email:

Emergency Contact: (other than yourself or partner)

Mr/Mrs/Miss First Name:

Surname:

Address:

Postcode:

Home Phone:

Work Phone:

Mobile Phone:

Email:

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Please tick:  Mon Tues Weds Thurs Fri

 

Pet Information:

Dogs Name:

Breed

Age

DOB

Male / Female

Spayed / Castrated

How old was your dog when you got it?

Is your dog chipped Microchip

Size: Small / Medium / Large

Approx weight:

Colour and specific markings if any:

 

Has your dog ever growled either at yourself, any member of the family (child or adult), carer, stranger?

Has your dog ever bitten/nipped either yourself, any member of the family, carer, stranger?

 

Medical Information

In an emergency or your is unwell, do you consent for us to take your dog for veterinary treatment?

Your vet will always be our first call.

If my dog’s own vet (listed on this form) is not available or my dog cannot be seen by this vet, I give my consent for my dog to be treated at the vet listed below.

Vet Name: Village Vets

Telephone Number: 01727 852667

Name, address and phone number of your vet 

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Insurance company

Policy Number
Please give details of any poor health issues:

Is your dog on any current medication or herbal remedies?

Please specify type and dosage:

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It is a requirement that your dog is on an up to date flea and worming programme.
Please specify the flea and worming programme and brand. We cannot accept boarding without proof of current vaccinations.
Details:
Flea Brand                       

How often is it administered?
Worming Brand

How often is it administered?
 

IT IS NOT A REQUIREMENT OF MARLEY AND ME'S DAY CARE THAT DOGS HAVE THE KENNEL COUGH VACCINE.
Are your dogs required vaccinations up to date at the time of filling in this form?       YES /NO
Has your dog had the kennel cough vaccine                                                                                   YES/ NO
Date of last vaccination 
If my dog requires preventative treatment, I give my consent that this is given under the direction of a
veterinarian.
I give consent for any medication described on my booking form, or any medication prescribed to my dog
by a vet in my absence, to be administered to my dog by the person caring for my dog.        YES / NO
If there is evidence of external parasites (fleas, ticks, lice) your dog must be treated with an appropriate
product authorised by the Veterinary Medicines Directorate and licensed for use on animals in the UK.     YES / NO 
Treatment will be discussed with a veterinarian before administering. Do you consent to us carrying out this
treatment?

 

Feeding – All food is to be supplied by yourselves.

Time of Feed & Quantity:
Type: dry biscuit, cooked, raw, tinned , other 

Brand of food:
Is your dog possessive over food?        YES / NO 
The owner is welcome to provide treats for their dog

 

Exercise
Describe your dog’s level of obedience, and any command words that you dog responds to: Please advise
Does your dog have a Sit?                                                                                                         YES / NO
Does your dog have a Wait/Stay?                                                                                            YES / NO
Does your dog have a Recall?                                                                                                   YES / NO
Any other words they respond to

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Where does your dog usually sleep? (please specify)
Is your dog crate trained?                                                                                                          YES / NO
Does your dog pull on a lead when out for walks?                                                                   YES  / NO

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IS YOUR DOG LIKELY TO (Please circle the appropriate answer)
Disclaimer: This is to assess how your dog can be expected to behave whilst boarding with us,
and alert us if they do anything that may be out of character.
JUMP ONTO FURNITURE?                        NEVER  /  OFTEN  / OCCASIONALLY
JUMP UP AT PEOPLE?                                 NEVER / OFTEN  /  OCCASIONALLY
BARK (When?)                                                 NEVER / OFTEN /  OCCASIONALLY
WHINE (When?)                                              NEVER / OFTEN / OCCASIONALLY
CHEW FURNITURE?                                     NEVER / OFTEN / OCCASIONALLY
CHEW STICKS?                                              NEVER / OFTEN / OCCASIONALLY
FIGHT WITH OTHER DOGS?                    NEVER / OFTEN / OCCASIONALLY
SCRATCH AT CARPETS OR DOORS?   NEVER / OFTEN / OCCASIONALLY
Does your dog chew other things?         NEVER / OFTEN / OCCASIONALLY
Can your dog be left alone?                       NEVER / OFTEN / OCCASIONALLY
Does your dog mess or urinate in the home?     NEVER / OFTEN / OCCASIONALLY
How does your dog react to having it's body, legs, ears, paws and tail touched?

 

How does your dog react when the door is knocked?
 

How does your dog behave/react when meeting other dogs off lead?
 

Are there any particular behaviours that Marley and Me's Day Care need to be made aware of?

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​Your dog will be socialised as per information provided by the owner. After the initial “Meet & Greet”, a familiarisation programme will be carried out in the Home Boarding environment. Notes will be recorded and kept securely on our Dog Boarding Software and referred to when necessary.

Do you consent for your dog to eat with other dogs present in the room, as long as the necessary precautions
are taken to prevent any incident of food aggression? We do aim to feed separately.                                      YES / NO 
Do you consent with your dog being walked both on lead and off lead with other dogs, both our
residential dog and dogs from different homes?                                                                                                      YES / NO
Do you consent to your dog to be allowed access to outside areas (ie garden) with other dogs staying here?      YES / NO
Do you consent for dogs to be transported in the car? They will be secured by a seatbelt lead or in the boot?    YES / NO
Do you consent for your dog to be walked outside the home environment / garden?                                            YES / NO
Do you consent for your dog to be let off the lead?                                                                                                  YES / NO
Do you consent for your dog to be walked with dogs other than those from its household?                                YES / NO
Do you consent for us to keep your dogs together in a designated room? (If applicable)                                    YES / NO
Do you consent for us to separate dogs from the same household if it becomes necessary? (If applicable)        YES / NO
Do you consent for your dog to use enrichment toys and equipment both inside the house and garden?              YES / NO
Do you consent for us to take videos and photographs of your dog to post to our Facebook page and website?  YES / NO

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Have you read and agree to the Policies and Procedures available on www.marleyandmedoggydaycare.com?    YES / NO

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I agree to pay £40 for Day Care between 8:30 AM and 6 PM                                                                                        YES / NO

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I CONFIRM THE INFORMATION IN THIS FORM IS CORRECT TO THE BEST OF MY KNOWLEDGE

Name

Signed

Date
The purpose of this form is to obtain as much information about your dog so that a correct decision can be made if Marley and Me Doggy Day Care  is a suitable environment. Details required such as behaviours, age,  medical conditions, neutered / castrated are all bought into consideration for a booking to be agreed upon by both Owner and Marley and Me Doggy Day Care. Personal contact details are required so a line of communication can be maintained at all times. Likewise, the client must feel they are able to contact the day care establishment if any problems arise during the duration of the stay. Dog's are individuals and each booking is treated individually at the discretion of Marley and Me Doggy Day Care. 
 

By completing this form you are agreeing to our policies and precedes available on the website to view

 

Any other information
If there is any other information you feel we need, please comment below;

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