APPLICATION FORM Owner's Information First Name: Last Name: Address: City: Province: Postal Code: Place Of Employment: Home Phone: Work Phone: Cell Phone: Email Address: Emergency Contact (other than self): Relationship: Please list other persons authorized to pick up your dog (name & phone): How did you hear about Doggie In The Window? Dog's Information (general) Dog's Name: Breed: Colour: Gender: Spayed/Neutered: YesNo Age: Birthday: Weight: Any special instructions for feeding? (if applicable) Any food allergies or sensitivity? Can your dog have treats?: YesNo Dog's Information (health) Veterinary Clinic's Name: Phone: Any Medical/Health conditions, injuries, or allergies?: YesNo If yes, please describe: Is your dog currently taking any medications? YesNo If yes, please describe: Does your dog have any sensitive areas on his/her body? YesNo If yes, please describe: Does your dog currently have a problem with fleas? YesNo If yes, please describe: Dog's Information (personality & temperament) Describe your dog's personality (mark all that apply): MellowCalmShySubmissivePlayfulHigh EnergyDominantAlphaWell BehavedUnruly Please mark all that apply to your dog: Food PossessiveToy PossessiveJumps Up On PeopleBarks ExcessivelyMouthyBitesChews ExcessivelyDigsSeparation AnxietyEats FecesDoes Not ObeyEats RocksFear of Loud NoisesHigh StrungTimidJumps FencesGrowls at StrangersDestroys FurnitureDestroys Toys/Clothing Does your dog socialize/play with other dogs on a regular basis? YesNo If yes, please describe: Has your dog ever bitten a person, dog or other animal? YesNo If yes, please describe: Has your dog ever shown aggressive behaviour towards people? YesNo If yes, please describe: Is your dog ever aggressive around other dogs or puppies? YesNo If yes, please describe: Are there any specific types of people, dogs, animals or situations that your dog dislikes or fears? YesNo If yes, please describe: Is your dog afraid of any specific items, noises or situations? YesNo If yes, please describe: Is your dog an escape artist or does your dog like to run away? YesNo If yes, please describe: Anything else we should know about? To the best of my knowledge, the information that I have provided on all pages is both accurate and true. I also acknowledge that I have read, understand and agree to abide by the Policies and Procedures. Owner’s Signature: Owner’s Name (please print): Date: Check here to indicate that you have read and agree to the terms in our Policies and Procedures.