Client Intake Form

    Owner Information

    Name of Owner(s):

    Street Address:




    Home Phone:

    Work Phone:

    Cell Phone:

    Email address:

    Emergency Contact:

    Emergency Contact Phone:

    Persons authorized for Pickup other than owner:

    How did you hear about Lucky Dog Daycare?

    Pet Information

    Pet’s Name:





    Date of Birth:

    Sex MaleFemale

    Altered? YesNo





    Getting To Know Your Pet

    Please complete the following questions. It is very important for us to have information on the pet’s background. This information assists us in introducing your pet to our daycare program.

    Is there anything your dog does not tolerate well; being lifted, nails clipped, ears cleaned, rough play, taking his bone or treat away, or other?

    Does your dog have any physical limitations? (please be specific)

    Has your dog had prior interactive daycare, group play or obedience training? (please provide details)

    When was the last time your dog has played in a group setting with 5 or more dogs?

    Are there other pets in your household? If so, please list.

    Has your dog ever growl, bit or snapped at another dog, if so how severe?

    How does your dog act around other dogs? Please check all that apply:
    Very playfulSomewhat playfulPlays roughMounts while playingUnsure at first but warms up quicklySometimes prefers to be by themselvesShy around other dogsWould prefer to be with quiet dogs

    Has your dog ever bit a person? How severely? Please explain the situation?

    Is your dog on any medications? If so, please list.

    What type of flea and tick preventative do you use?

    What type of heartworm preventative do you use?

    Does your dog have any specific dietary limitations or allergies to specific foods?

    Is there any additional information you would like to tell us about your dog(s)?

    Do you have any questions or specific interests you would like addressed?

    What days of the week do you expect you will be bringing your dog to daycare?

    What time do expect to drop off your dog?

    What time do expect to pick up your dog?