Registration Form for Dogs: Dog Owner’s Name: __________________________________________________________________________ Address: _____________________________________________________ City: _______________________ State: _____________ Zip Code: ________________ Phone Number(Home): _______________________ Phone Number (Cell): _____________________________ Phone Number(Work): _______________________ Phone Number (Vacation): _________________________ Email Address: _____________________________________________________________________________ *Your email will remain private and will be used only to confirm reservations and/or to announce special offers* Emergency Contact if you cannot be reached: (Name, Phone Number & Relationship) ____________________ _____________________________________________________________________________________ _____ Veterinarian’s Name: ________________________________________________________________________ Veterinarian’s City/State: _____________________________________________________________________ Veterinarian’s Phone Number: __________________________ Pet’s Information: Dog’s Name: ___________________________________________________________Age: ________________ Page 1 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 Male / Female Spayed or Neutered: Yes / No Breed: ______________________ Color: __________________ Approximate Weight: ______________lbs Feeding Instructions (amount, times of day, special food, etc)________________________________________ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ Brand and/or Type of Food: ___________________________________________________________________ Favorite Toys / Games: _______________________________________________________________________ Food Allergies / Restricted Food: _______________________________________________________________ _____________________________________________________________________________________ _____ Medical Conditions (List any Past or Present): _____________________________________________________ Page 2 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ Medication(s) (Name, Dosage, Frequency): _______________________________________________________ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ Has your dog ever been boarded anywhere before? Yes / No If yes, did you or your pet have any trouble or concerns? Explain _____________________________________ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ Has your dog ever been aggressive towards humans? Yes / No Has your dog ever been aggressive towards children? Yes / No Has your dog ever bitten someone? Yes / No Is your dog crate trained? (ie a few hours locked in an appropriate sized crate) Yes / No Does your dog have any of the following? Check all that apply and then explain: o Dog Aggression o Deafness o Blindness o Object Guarding o Storm Anxiety o Separation Anxiety o Fears/Phobias o Diabetes Page 3 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 Please Explain Any Checked: ___________________________________________________________________________________ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ _____________________________________________________________________________________ _____ Has your dog ever played with or been around other dogs before? Yes / No Has your dog ever been aggressive toward another dog? Yes / No Has your dog ever bitten another dog before? Yes / No Has your dog ever been to a dog park? Yes / No If yes, did your dog do well with the others? Yes / No Has your dog ever been in doggie daycare before? Yes / No If yes, has your dog ever been kicked out of doggie daycare? Yes / No If yes, Why? _____________________ _____________________________________________________________________________________ _____ Will your dog be staying in the same suite with his or her fur sibling(s)? Yes / No Has your dog ever been aggressive toward his or her fur sibling(s)? Yes / No Do your dogs eat in the same room as each other? Yes/No Have your dogs ever stayed alone together before? Yes / No Are your dogs litter mates? Yes / No *Please note that if at anytime during your pets’ stay we feel that they need to be separated to feel more comfortable, we will do so for the safety of the dogs.* Please describe any other information we should know about your dog: _______________________________________ Page 4 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 _____________________________________________________________________________________________ _____ _____________________________________________________________________________________________ _____ _____________________________________________________________________________________________ _____ Has your dog ever been groomed before? Yes / No Does your dog tolerate baths well at home? Yes / No Has your dog had his or her nails clipped before? Yes / No Is your dog sensitive to touch anywhere on his or her body? (ie ears, feet, etc) Yes / No If yes, explain: ________________________________________________________ General Policies: Please initial all the following below, stating that you have read, understand, consent, and agree to the following policies to obtain our doggie daycare, grooming, and/or boarding services. Registration: I represent that I am the legal owner or agent for the owner of the pet described in this application form. The Farm at Flint Creek (sometimes referred to in this document as “The Farm”) reserves the right to prohibit admittance to any pet for, including but not limited to, the following reasons: dogs must be at least 14 weeks of age before coming to our facility, pets must have proof of all required vaccinations, pets displaying any signs of an untreated or potentially contagious illness, pets that seem aggressive or have history of aggressive behavior towards people or other animals, AND all pets must have complete, up-to-date, and approved documentation on file including a complete registration form for each pet, medical and vaccine records for each pet, signed registration form and agreement for each pet. The Farm has the right to prohibit admittance to any pet we do not feel is a good fit for our facility. The Farm reserves the right to permanently remove my dog from its daycare or boarding facilities or grooming services at any time. I understand, _________initials Page 5 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 Vaccinations Required: Written confirmation of current vaccinations from your veterinarian are required for ALL animals obtaining services at The Farm with no exceptions. All pets must be current in accordance with our policy. Dogs: ✓ Bordetella Vaccine Required ✓ DHLPP / Distemper / Parvo Virus Vaccine Required ✓ Rabies Vaccine Required ✓ Canine Influenza H3N2 or H3N2/H3N8 Bi-Valent Recommended ✓ Flea & Tick Prevention Recommended ✓ Puppies should have received all rounds of puppy shots, including rabies, and have been vaccinated against Bordetella. IMPORTANT! With permission, any dog where we visually see a flea on them will be administered a Capstar pill upon arrival. We will separate your dog and call you first! Universal administration minimizes the risk that your pet will be exposed to fleas, both in the facility and transmission from other dogs and cats. If you wish for your pet NOT to receive a Capstar, please DO NOT sign in the box below. If you sign below, you are consenting to any and all risks that may be associated with Capstar, including but not limited to side effects, injury, or death. Signature: _______________________________________________ Date: ___________________________ Printed Name:_________________________________________ Pet’s Name:__________________________ Hours: Lobby Hours and Drop-Off/Pick-Up Times are as follows with no exceptions: Monday – Friday: 7:00am-5:30pm Saturday: 9:00am-11:00am and 3:00pm-5:00pm Sunday: 9:00am-11:00am Please schedule your drop-offs and pick-ups with one of our staff members so we can have everything ready for your arrival or pick-up. Page 6 of 15 The Farm At Flint Creek 6622 State Road 25 S West Point, IN 47992 There is a full-day boarding fee charged on day of arrival, regardless of check-in time and there is a full-day charge on the day of pick-up, regardless of pick up time. I understand, _________initials Contagion Exposure and/or Flea & Bug Exposure: Animals, especially dogs, just like humans or children, are susceptible to transferring contagious illnesses between animals. Visiting areas where animals