Blue Ribbon Boarding Kennels
Action Bark Dog Park Daycare
319 Main Street South
Bethlehem, Ct. 06751
(203)266-7036
Dogs Name: __________________________ Date: ____________________________
Owner Information
Name: _______________________________________________________________
Address: ______________________________________________________________
City: _________________________St: _________ Zip Code: __________________
E-Mail Address:_________________________________________________________
Home Phone: ___________________________Cell Phone: _____________________
Employer: ______________________________Work Phone: ____________________
Spouse’s Name: ______________________Employer: __________________________
Spouse’s Work Phone: ____________________Cell Phone: ______________________
Cost $25.00 @ Day prepay for 10 days get 1 day free !
Credit Card: Visa or Master Card (circle one) Number: _____________________exp:_________
Emergency Contact (Someone other than you and your spouse)
Name: ________________________Home: _________________Work: _____________
Name: ________________________Home: _________________Work: _____________
Pet Information
Name: _______________________________ Breed: ___________________________
Sex: Male Female Spayed/Neutered? Yes No
DOB/Current Age: _________________ Weight: __________________________
Veterinarian Information
Vet Office’s Name: ________________________________________________________
Address: ________________________________________________________________
Telephone: ______________________________________________________________
Check the top 3 reasons you have chosen day care for your dog:
_____ Physical exercise/Energy release _____Mental health/Social stimulation
_____ Dog is home alone too much _____ Friend’s dog has benefited from it
_____ Recommendation from vet _____ Assistance with housebreaking
How did you hear about Blue Ribbon Kennels? ________________________________________
GENERAL INFORMATION
How long have you owned your dog? ________________________________________
Where did you get your dog? ______________________________________________
PARENTS & DOG
Is your dog housebroken? Yes No
Has your dog attended or received basic obedience training? Yes No
Circle any of the following commands your dog knows:
Sit Down Stay Come Heel Off
Does your dog have a bathroom command? Yes No Describe _____________
What signals does your dog use to show you they need to go out? ________________
Does your dog have a quiet command? Yes No Describe ___________________
Does your dog do any of the following at home (please circle all that apply):
Chewing Nipping Running Away Jumping Excessive Barking
Digging Growling Ignoring Commands Pulling on Leash Shy Away
Other problems? ________________________________________________________
Is there anything in particular that frightens your dog? ___________________________
Is there anything that over-excites your dog? __________________________________
PEOPLE SOCIALIZATION
How does your dog react when visitors come over? ____________________________________
How does your dog react to strangers? ______________________________________________
Has your dog ever growled or snapped at ANY person? Yes No
If yes, please describe the circumstances: __________________________________________
Has your dog ever bitten (made contact with teeth) ANY person? Yes No
If yes, please describe the circumstances: __________________________________________
OTHER DOGS
How often has your dog had the chance to play with other dogs? _________________________
Describe how your dog plays with other dogs: ________________________________________
Are there any kinds of dogs that your dog seems to prefer? Yes No
Describe: _____________________________________________________________________
Are there any kinds of dogs that your dog seems to dislike? Yes No
How do you know? _____________________________________________________________
How does your dog react when he/she sees another dog?
How does he/she react when actually approached by another dog?
Has your dog ever been in an altercation or fight with another dog? Yes No
If yes, please describe the circumstances: ___________________________________________
Has your dog ever WOUNDED another dog in ANY way? Yes No
If yes, please describe the circumstances: ___________________________________________
CRATE/SLEEPING
Is your dog used to being in a crate? Yes No
Where does your dog sleep at night? _______________________________________________
Where does your dog stay when you’re not at home? __________________________________
Is your dog protective of his crate or bed/resting area? Yes No
PLAY TIME
Does your dog like to play? Yes No
Describe how your dog plays with you? ____________________________________________
Does your dog entertain him/herself with play and toys? Yes No
How does your dog react to young, boisterous puppies? _______________________________
NUTRICIAN
What do you feed your dog? __________________________________________________
How much do you feed? ____________________ How many times a day? ____________
Is your dog protective of his food or treats? Yes No
PHYSICAL HEALTH & GROOMING
Do you use a flea/tick preventative program? Yes No Type _________________
Does your dog have any allergies? Yes No Describe __________________________
Does your dog require medication? Yes No
Are there any places your dog doesn’t like to be touched? Yes No
If yes, how do you know?
Where is your dog’s favorite spot to be petted? ________________________________
Any other concerns: