Today’s Date: _____________

Client Name_________________ Dog’s Name______________________
Address___________________________________ Age_____ Breed___________________
Phone (res)_________________ Sex: Male Female (circle one)
            (bus)_________________         Neutered/Spayed
Cell phone/pager_______________________________________________
E Mail________________________________________________________
Colour & Markings of Dog:________________________________________________________
Date of Boarding period/drop off and pick up times:_____________________________________________________
Dog’s Characteristics: Please state yes or no beside each statement:
Comes when called ______ Good with other dogs _______
Plays with ball _____ Will go in water _______
Likes children ______ May be given treats _______
Must be kept on leash ______ Scared in thunderstorms ______
Chases joggers/squirrels/cats ______ Barks at strangers ______
Loves garbage/people food ______ May be allowed on furniture ______
Jumps/climbs/digs ______ Likes to chew ______
Dog’s background (ie. Acquired as puppy/from Humane Society, etc.):__________________ ______________________________________________________________________________
Veterinarian: Name of Clinic:_____________________________________________________
Number where you may be reached:_____________________________________________________
Friend or neighbour that may be contacted in client’s absence or emergency:
Any additional comments or special requirements (ie. feeding schedule/medications/allergies:
Signing below acknowledges that Jog-A-Dog personnel may enter your home for the purpose of picking up/returning your pet and to transport your pet by car. Jog-A-Dog and its personnel shall assume no liability for any illness or injury caused to your pet or to other persons, pets or property. If your pet becomes injured or ill, Jog-A-Dog is hereby authorized to take your pet to the nearest animal care facility and such expense shall be paid by the owner of the pet.


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