New Customer Form – The DogHouse Inn

Name *

First

Last

Address *

Address Line 1

City

State / Province / Region

Postal Code

Phone *

Email *

Do you require Boarding or Daycare? *

Boarding
Daycare

Any specific requirements or information we should know?

The more we know about your dog, the better we can help make him/her more happy.

Dog name/s & DOB / Age? *

Please indicate the name or names of your dogs THERE DOB & age please?

Breed/s & Colours *

Microchip Number/s (If you know it)

Sex *

Male
Male (neutered)
Female
Female (neutered)

Drop-Off Date *

Drop-Off Time *

Monday – Friday 7.00am – 10.30am
Monday – Friday 3.30pm – 6.00pm
Saturday – 8.00am – 10.30am
Sunday – 3.30pm – 6.00pm.

Pick-Up Date *

Pick-Up Time *

Monday – Friday 7.00am – 10.30am
Monday – Friday 3.30pm – 6.00pm
Saturday – 8.00am – 10.30am
Sunday – 3.30pm – 6.00pm

Date on the Vaccination Certificate *

An up to Date Vaccination Certificate is required. Your dog cannot board with out it.

File Upload

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload a photo or image of your dogs Vaccination Certificate.

Last Wormed Date *

Name of your Vet & Phone Number? *

If we need a vet urgently we will call Chinchilla Vets. If you don’t want us to call them please let us know.

Permission to Call Vet on your behalf? *

Yes
No

By agreeing and click yes to understand that you will be liable for all expenses.

Any medical condition needing attention? *

Yes
No

Special Needs or Allergies / Medication required to be GIVEN.

All medication must clearly be labeled with Name of Medication, Dog’s name and Dosage as prescribed by the vet.

Indicate how social your dog/s are: *

Sociable to both humans & animals, Friendly to people only, Aggressive, Re-active to other dogs, Separation Anxiety, Scared of Storms, Jumps Fences, Chews dog beds.

Emergency contact *

First

Last

Person other than yourself in the case we are unable to contact you.

Emergency contact person's number? *

In the event of an emergency, contact me for……. *

Major incidents
Minor incident
Any incident
At Kennel Management Discretion

Medical Expense – I agree to pay…….. *

Yes, only up to the cost of $1000.00
Yes, up to the vets discretion (no price limit)
No (by clicking NO if something happens and we have not called the vet we are not blamed)

If you do not want us to contact the local vet, please be aware that you take full responsibility for any outcome which may cause death or injury to your dog/s.

In case of death: *

Contact me immediatley
Contact my emergency contact
Will discuss on Drop Off
Do not know

Additional Services we Offer?

Any costs relating to the above will be charged and payment due at time of pickup if they aren’t stated when booking form in processed.

Do you give Permission to take photos, & use in any multi-media format? *

Yes
No

All photos, vidoes, etc are the property of The DogHouse Inn and are not for sale.

Food / Equipment you will supply: ( please tell us how much food you feed your dog / day.) *

For the well-being of your pet, we only require their dry biscuits. The reason being that your dog is use to his/her own food, which is comfort to them. Also by not changing there normal food they won’t get an upset stomach.

How did you here about us? *

I agree to the Terms and Conditions *

I have read and agree to the Terms of Service