Client Form

(All items are required to fill out)

Owners Name:    Address:

Neighbourhood:   Primary Contact #

Secondary Contact #      Your Email

Pet 1

Pet Name: Date of birth:

Breed: Colour:

MaleFemale SpayedNeuteredMedical Issues/Medications

Is there anything special we should know about the pets condition:

Veterinary Contact:

Vets Name:



House trained? yesno

Crate trained? yesno

Where does your pet like to sleep?

Wire CratePlastic CrateDog BedOwn RoomAnywhere in the houseSofaOwner’s bed

Where does your pet stay when you go out?
Wire CratePlastic CrateFree in homeclosed in a room

What are your pet’s favorite activities?
FetchChew toystugon leash walksoff leash walksplaying with other dogs,

Destructive behaviours?
Chews shoeschews furnituregets into garbageeats socksmarks territorysteals from counter/table

Risk behaviours?
climbs fencedigs under fencebolts out doorguards foodguards toysguards bed/furnitureguards people

Good with children?
YesNoNervous of childrenunknown

Good with adults?
YesNoNervous of menNervous of women

Good with dogs?
YesNoUnknownOff leash only

Good with cats?

Aggressive incidents towards people?
(please provide details)

Aggressive incidents towards animals?
(please provide details)

Please describe your pet's eating routine?
(time, amount, type of food)

Other details you would like to share:
(please provide details)

Second Pet

Third Pet

Prefer home with no other pets?
YesNoNo preference

Emergency Contact 1:

Contact Name:


Emergency Contact 2:

Contact Name:


Authorized veterinary costs in a medical emergency (if we are not able to reach you) $

List pet’s belongings that you plan to leave with your pet:
bedcrateblanketleashharnesshaltipinch collare collarbowl(s)coatbootiesbrush

Agreement to Hold Harmless Waiver and Assumption of Risk

I understand that dog daycare and boarding is not without risk to my dog. There may be situations where risk is increased through interaction with the public, other dogs, and stressful scenarios for my dog.

I hereby waive and release Carp Country Canines and Bobbiann Geller hereinafter from any and all liability of any nature for injury, damage or loss which my dog may suffer including specifically but without limitation, any injury or damage resulting from the action of any dog.

In consideration of and as inducement to the acceptance of my registration for daycare and boarding with Carp Country Canines and Bobbiann Geller, I hereby agree to indemnify and hold harmless Carp Country Canines, Bobbiann Geller, its employees, officers, agents from any and all claims.

I have read, understand and accept these terms. This must be checked in order to activate the SEND button.

Privacy Policy:

Carp Country Canines has a policy of protecting customer privacy.

We will not sell your personal information to a third party. We will not disclose your personal information to a third party except in the event of a medical emergency where a veterinary care provider may require your personal information.

Carp Country Canines will revise and update this Policy as it deems appropriate, including, for example, if our practices change or if changes in the law so require. You should refer back to this page for the latest information.