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APPLICATION FORM
OWNER DETAILS
Owners' Name
*
Email
*
Address
Preferred Phone Number
*
Work Phone Number
EMERGENCY CONTACT
Emergency Contact Full name
*
Emergency Contact relationship to you?
*
Emergency Contact Number
PET INFORMATION
Dog's Name
*
Dog's Age
*
DOB
Breed
*
Colour
*
Gender
*
Desexed? (yes or no)
*
How long have you owned your dog?
*
BEHAVIOUR
How does your dog react in social situations?
*
Has your dog ever showed signs of aggression or fear?
*
Yes
No
If yes, under what circumstances?
Does your dog have any issues with other animals?
*
Is your dog possessive or aggressive with toys?
*
Yes
No
If yes, how does he/she react?
Is your dog a jumper?
*
Yes
No
If yes - up to what height?
Does your dog have any issues or medical conditions we should be aware of, including if they are a special or restricted diet?
*
Are you ok with your dog being given treats as a reward for good behaviour?
*
Yes
No
If you do not wish for your dog to get treats, what would you prefer?
Are there any other interesting things you’d like us to know about your dog?
*
VET PRACTICE DETAILS
Vet Practice Name
*
Vet's Address
*
Vet's Phone Number
*
In the unlikely event of a medical emergency, please indicate your preference below
*
Please contact me and take my dog to my preferred vet
Please contact me and take my dog to the nearest vet for immediate assistance
HOW DID YOU FIND OUT ABOUT US?
How did you hear about the Dog Lounge?
ACKNOWLEDGEMENT & SIGNATURE
I give permission for the Dog Lounge on Clarke to use photos of my dog on social media or our website for advertising
*
Yes
No
I understand that I will be held accountable for any medical/vet costs in the event that my dog causes injury to another dog
*
Yes
No
Full name of owner
*
Your Signature
*
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*
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