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welcomequestions - CamperApplication Page 1 of 3 New Canine...

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New Canine Camper/Interview Additional Family Member Existing Camper’s Updated Information Guardian’s/Owner’s Name_______________________________________________________________ Address _____________________________________ City _________________State ___ Zip _______ Home Phone # (___) ______________ Work# (___) ________________ Cell # (___) _________________ E-Mail Address _____________________________ Web Address ________________________________ Canine Camper Name________________________________ Birth Date___/____/___Weight _________ lbs. Breed _____________________________________ Sex: Male Female Color __________________ Yes, my Camper is: Spayed Neutered Veterinarian Hosp________________________Contact Name ________________ Phone # (____) _________ Address __________________________ City ____________________ State _______Zip __________ HOW DID YOU HEAR ABOUT CAMP BOW WOW? Drive-By Website Yellow Pages Direct Mail Newspaper Flyer E-Mail Special Event Other ___________________________________ Have you ever used Doggy Day/Overnight Boarding services? No Yes, please list______________________________ Have you visited a Camp Bow Wow location before? No Yes, please list ______________________________ What are your primary reasons for bringing your Dog to Camp Bow Wow? Loves To Play Travel Extensively Work Long Hours Don’t Like to Leave Alone All Day Is there any PERSON, type of DOG, or SITUATION your dog seems to have a problem with? Yes No Please describe ____________________________________________________________________ How long have you had your dog? __________________________________________________________ Where did you get your dog? ____________________________________________________________ Has your dog ever growled at or bit another PERSON or DOG? Yes No If yes, what were the circumstances? _________________________________________________________ Can you take a food item away from your dog without him growling? Yes No Will your dog readily share toys with other dogs? Yes No Yes No Are there any areas on your dog’s body where they DO NOT like to be touched by humans? Yes No If yes, which areas? __________________________________________________________________ Yes No Please describe ____________________________________________________________________ Has your dog ever played with dogs over 15 pounds? Yes No Are there any restrictions that should be placed on your dog’s activities? Yes No If yes, what activities? ________________________________________________________________ What else should we know about our future Canine Camper? ____________________________________________ CamperApplication Dog Needs A Vacation CANINE BEHAVIOR QUESTIONS: (Please answer the following questions as accurately as possible.) VACCINATIONS: Guardian/Owner is required to provide veterinary proof of current Rabies, Distemper and Bordetella. Has your dog ever jumped a fence or barrier? Please describe ____________________________________________________________________ Has your dog ever socialized with a large group of dogs? (8 or more) Yes No Has your dog ever played with dogs under 15 pounds? No, my Canine Camper is not spayed/neutered (required at 6+ months) Referral: Name _________________________ Page 1 of 3 Continued on page 2
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EMERGENCY CONTACT NAME (someone not traveling with you) ____________________________Relationship _____ Home Phone # (____) ______________ Work # (____) _____________Cell # (____) ________________ PAYMENT METHOD for Day and Overnight Camp Fees: (Two Credit Cards Required) Persons Authorized to Drop Off and/or Pick-Up My Camper(s) __________________________________________ Camp Bow Wow: Accepted this application ______ of___________ 20____ ___________________________ Day Month Year Camp Bow Wow Representative I, the undersigned, hereby acknowledge and agree that all the information provided in this Camper Application is complete and accurate to the best of my knowledge. Waiver of Liability, Assumption of Risk and Indemnification Agreement (the “Agreement”), as they may be amended from time to time, which are attached and fully incorporated into this application. I hereby execute the Agreement for my dog, myself and my heirs, successors, representatives and assigns. I further attest that if I am
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