Owner Information Form - Scissor & Suds

This form needs to be submitted per dog.

Owner Information

Name *

Email Address *

Street Address *

City / Town

Postcode

Home Phone *

Mobile Phone

Emergency Contact Details *

Dates of boarding required including drop off/collection times 8.30am until 7pm *

Dog Description: Name *

Breed/Colour *

Age *

Select Male or Female *

Is your dog neutered? *YesNoN.B; We are unable to accept un-neutered animals unless already discussed

Date of last season

DD-MM-YY

Please provide details of your dog’s feeding regime. *

Veterinary Surgery Contact

We will aim to use your veterinary surgeon wherever possible but in case of an emergency we will use our discretion.

Name and address of surgery *

Surgery Telephone Number *

Please provide the date of the last vaccinations.

(Vaccinations must be current as advised by your vet. Please email a copy of the vaccination record over so I have it in advance (or attch below) so there are no unexpected issues on arrival. This is part of the boarding license conditions by East Herts council.)

Vaccination Record - Upload file

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Worming Treatment *Please provide dates and what was used for the last

Flea TreatmentPlease provide dates and what was used for the last

Health & MedicalPlease provide any further information you deem important regarding your dog’s health and medical history. This should include any medication, allergies, operations, injuries, gland issues, water infections, arthritis etc

Dog Behavioural information

Please be honest as this will help us to help your dog feel at home with us and manage his/her needs appropriately.

Where does your dog sleep? *

Is your dog good with other dogs and are you happy for them to be kept with dogs from another family? *YesNo

How much exercise does your dog receive a day? What is he/she's normal routine? *

Are you happy for your dog to be walked with other dogs? *YesNo

Are you happy for us to walk your dog off lead away from roads? *YesNo

Is your dog crate/cage trained and if so would you like him/her to still use it? *

What is the average amount of time you would ever leave your dog alone at home? *

Are you aware that your dog barks/howls if left or suffers from separation anxiety? *

Is your dog comfortable around small children? *YesNo

Is your dog comfortable around horses? *YesNo

Does your dog travel well in the car? *YesNo

Does your dog ever chew anything other than it’s own toys? *YesNo

Insurance Information

If your dog is insured please provide the name of the insurer and the policy number *

Owner Statement

I have been offered a meet and greet prior to my dog coming to stay and I am happy to place my dog in the care of Melissa and Stuart. I am not aware of any reason why my dog should not settle within a home boarding environment *Agree

I agree to the charge of £40 per night *Agree

If my dog is destructive during the stay, I agree to pay for any damages or costs incurred *Agree

If my dog requires any veterinary treatment, I hereby authorise for my dog to be taken to a veterinary surgery and agree to pay the costs incurred on advice of the veterinary surgeon *Agree

I agree to Terms & Conditions *Agree

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Any Other Information

Signed *

Owner Name *

Date *