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Welcome Home Boarding
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GALLERY
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INTAKE FORM
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Welcome Home Boarding
Boarding Intake Form
Owner information
Full Name
*
Phone
*
Email
*
Address
*
Emergency Contact Name
*
Emergency Contact Number
*
Authorized Pickup Person(s)
Dog's General Information
Dog's Name
*
Breed:
*
Age:
*
Date of Birth
*
Month
Day
Year
Weight
Sex:
Male
Female
Is the dog Spayed/Neutered?
Yes
No
Dog's Health Information
List any medical problems, surgeries, physical limitations:
Does your dog have any activity limitations?
Yes
No
If yes, please describe.
Consent & Acknowledgments
Heartworm Medication:
Heartworm medication date received:
Month
Day
Year
Flea/tick medication:
Flea/tick medication date received:
Month
Day
Year
Any bowel/bladder control issues?
Yes
No
If yes, please describe.
Any allergies (including food)?
Yes
No
If yes, please describe.
Any sensitive body areas?
*
Yes
No
If yes, please describe.
Behavior & Socialization
Is your dog socialized with other dogs?
*
Yes
No
Is your dog socialized with people?
*
Yes
No
What is your dogs play style? (Check all that apply)
*
Rowdy
High Energy
Bully
Humper
Chaser
Tackler
Vocal
Cooperative
Wrestler
Laid back
Doesn't Care
Other
Does your dog play with other dogs
Yes
No
Sometimes
Other
Does your dog prefer to socialize with dogs of a certain sex?
*
No preference
Male dogs
Female dogs
Does your dog fear or dislike certain dogs?
Yes
No
If yes, please explain:
How does your dog typically react to puppies?
Describe your dog’s overall personality:
How does your dog usually behave around other dogs? (Check all that apply)
Submissive/Shy
Fearful
Relaxed/Calm
Dominant
Nervous / Cautious
Always friendly
Friendly once familiar
Hyper/Busy
Playful
Aggressive
Unpredictable/Unruly
Other
Reaction to meeting new dogs off-leash:
Reaction to meeting new dogs on-leash:
Does your dog dislike or react negatively to certain people, animals, or situations?
Yes
No
If yes, please describe:
What specific things does your dog fear or dislike? (Check all that apply)
Men
Women
Children
Hats
Uniforms
Shoes
Canes
Vacuum Cleaners
Walking Sticks
Cars/Trucks
Bicycles
Other
How does your dog typically react to strangers? (Check all that apply)
Submissive/Shy
Fearful
Relaxed/Calm
Dominant
Nervous/Cautious
Always friendly
Friendly once familiar
Hyper/Busy
Playful
Aggressive
Unpredictable/Unruly
Other
Does your dog have a strong prey drive? (e.g., chases small animals)
Yes
No
If yes, please explain:
Does your dog mount other dogs?
Yes
No
Does your dog urinate when excited or submissive?
Yes
No
If yes, which?
In what situations does your dog display inappropriate or concerning behavior? (Check all that apply)
During meals
While playing
Chewing toys
When disciplined
Around visitors
While sleeping
When touched
When hugged
While crated
During nail trimming
During baths
When grabbed by the collar
When meeting new dogs
At dog parks
Other
Who is your dog’s favorite family member?
How does your dog act during family interactions?
How does your dog react to strangers such as groomers or veterinarians?
Is your dog housebroken?
Yes
No
Has your dog ever been in a fight with another dog?
Yes
No
Does your dog resist nail trimming?
Yes
No
If yes, please describe:
Has your dog attended any training classes or private lessons?
Yes
No
If yes, please describe:
Does your dog respond to their name?
Yes
No
Which verbal commands does your dog understand? (Check all that apply)
Sit
Stay
Down
Stand
Come
No
Heel
Wait
Leave it
Drop it
Fetch
Stop
Find it
Other
Submit
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