Camp Lisa 916.824.2132

Dog Admission Form

How did you hear about us?

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Pet Parent Information

Name(s)(*)

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Address(*)

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City(*)

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State(*)

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Zip(*)

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Primary Phone(*)

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Work Phone

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Other Phone

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Other Phone

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Primary Email(*)

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Other Email

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Emergency Contact (other than yourself)

Name(s)(*)

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Phone(*)

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Name(s)

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Phone

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Name(s)

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Phone

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List any person(s) authorized to pick up your dog if you cannot

Name(s)

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Veterinarian Information

Name

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Clinic Name(*)

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Address

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Phone(*)

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Pet Information

Name(*)

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Breed(*)

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Color

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Sex(*)

MF

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Spayed / Neutered(*)

YN

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Birthdate(*)

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Weight(*)

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Pet Health

Current on ALL vaccinations?(*)

YN

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You will need to provide a current copy of the vaccination records when you drop off your dog.

On any medications now?(*)

YN

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If Yes, for what reason?

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On any medications recently?(*)

YN

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If Yes, for what reason?

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Does your dog have any injuries, hot spots, irritations, skin problems, bandages, stitches, or other problems our staff should be

aware of?

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Does your dog have any medical conditions that limit your dog’s activities or

movement?

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Any allergies?(*)

YN

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If Yes, what?

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What flea medication is your dog currently on?

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General Information

Where did you get your dog?(*)

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If adopted, when?

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Do you have any knowledge of your dog's past

history?

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Other animals in household?(*)

YN

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If Yes, please list type, sex and age of

each

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Boarded dog before?(*)

YN

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Where?

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Where does your dog stay most of the

time?(*)

IndoorsGarageOutdoorsOther

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More info

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Is your dog friendly?

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Feel free to give us more info

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Behavior

Bitten anyone?(*)

YN

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If so, what were the

circumstances?

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How does your dog react to strangers coming into your home or

yard?

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Does your dog act afraid of any specific items or

noises?

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Are there any circumstances where your dog is aggressive with other

dogs?

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Does your dog go to

Dog Parks?

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Jumps over fences?

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How high?

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Other comments about your dog which you feel we need to know and which might be

helpful

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If we provide other services, what would you be

interested in?

TrainingNature WalksSwimmingChiropracticMassage TherapyGrooming Invalid Input

Other

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(*)

I certify

Certification required

that I have read the Service Agreement and the Rules and Regulations set forth in the links provided and that I thoroughly understand these documents. I agree to abide by the rules and regulations and accept all the terms, conditions and statements of these documents.

(*)

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Submit

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