Send Rover On Over Doggie Daycare Application (805) 650-3294 650-DAWG                                                 Phone_______________________________ Dog’s Name: _______________________   Owners name ______________________ Breed: _____________________________   Color: ___________________________ Age: _______________________________   Birth date: ______________________ Gender/                 Neutered/ Spayed:      Intact  Fe        Intact Male     ( All daycare dogs must be spayed or neutered by 7 months of age.) Microchip?:       Yes       No                     Licensed?:       Yes       No Date of last Rabies shot: ________  Bordatella: ________  DHLPP: ________ Does your dog have any food allergies?__________________________________ Has your dog had any formal Training?:    Yes     No  Type of Training: ________________________ Are you interested in any of our Training Programs?  Yes           No Puppy       Basic Manners     Intermediate     Recall clinics      Agility for fun     Privates   Pet Sitting?    Yes         No       Massage or Healing Therapies?   Yes     No Is she/he on a flea and tick control program?:         Yes       No ( All daycare dogs must be on a flea/tick control program. Feel free to ask us or your veterinarian about options.) If yes, what type?: ___________________     Date of last dose: _____________ Has he/she previously been in social environments?:         Yes        No Circle those that apply:        Dog Park           Agility           Obedience                                                     Housemates          Daycare   Does he/she interact well with other dogs?:        Yes          No Has he/she ever bitten a human?        Yes          No Has he/she ever bitten another dog?:          Yes        No Is he/she house trained?:       Yes       No Circle “quirks” that apply:       Barking         Digging        Fence-jumping                      Jumping           Toy or Treat Aggression How is your dog with Larger Dogs, Smaller Dogs, Older Dogs and Puppies________________________________________________________________ What’s your reason for bringing your dog to daycare?: ___________________ What time would you like to bring and pick up your dog? ________________________________________________________________________ Is there anything else we should know about your dog?: _________________ ________________________________________________________________________ How did you hear about us?____________________________________________ Parent/ Guardian Info. Name(s) First___________________________Last___________________________ Address: ______________________________________________________________ City: ____________________   State: _________   Zip Code: ________________ Home/Phone:__________________________Cell/Work_______________________ E-mail__________________________________________________________________ Emergency Contact Name: _____________________________________________ Phone: ____________________________   Cell Phone: ______________________ In case you are unable to pick up your dog from daycare, who do you authorize to pick him/her up for you? Name:_____________________________   Phone: ___________________________ Name and Number of Veterinary clinic _________________________________ ________________________________________________________________________  __________________________________________                            _____________________                        Parent/ Guardian signature                                                      Date