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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

If yes, under what circumstances?

Does your dog have any issues with other animals? *

Is your dog possessive or aggressive with toys?*

Yes

If yes, how does he/she react?

Is your dog a jumper?*

Yes

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

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

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

Full name of owner*

Your Signature*

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Date*

Day

Month

Year

Contact

7 Clarke Road,

Te Puna,

Tauranga

p 07 552 4768

e info@doglounge.co.nz

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