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In-Home Boarding Intake Form

Please read and agree to the attached Waiver, Informed Consent and Policies document (click here):

Current - CCinc Waiver Sep 2023.docx

Name*

Email*

Address*

Phone*

What pronoun do you prefer?

She/Her/HersHe/Him/HisThey/Them/Theirs

Requested Dates for Overnight:*

Pet Name*

Breed*

Birthday*

Sex*

Spayed or Neutered *

YesNoUnknown

How many pounds does your dog weigh? *

How long have you owned this dog? (rounded in years)*

Where did you get this dog? (Please list name of shelter, breeder, etc.)*

In addition to you, list the names and ages of all people and animals in the household, including yourself:*

Is your dog or has your dog ever been aggressive towards people? *

No/yes

Has your dog ever bitten a person?

No/yes

Please describe any incidents.

Is your dog or has your dog ever been aggressive towards other dogs? *

No/yes

Has your dog ever bitten another dog?

No/yes

Please describe any incidents.

Is your dog or has your dog ever been aggressive toward small animals (cats, chickens, etc.)? *

No/yes

Please describe any incidents.

Is your dog reactive and/or fearful of other things (bikes, vacuum, etc.)? *

No/yes

If yes, please describe:

If yes, please explain:

List any equipment you use to walk your dog: *

Does your dog jump/climb fences? *

No/yes

If yes, what type/height:

Which most closely describes how your dog eats?*

Food is the best part of the day – barely stops to breathe Food is good – eats everything at a reasonable paceFood is so/so – may or may not finish a meal or needs "extras" to make it appetizingFree feed – food is out all the time

Does your dog bark a lot? *

No/yes

If so, list what he/she barks at (or situations in which they bark) and anything you've done to try to prevent it.

Does your dog chew or destroy any human items in the house or yard? *

No/yes

Is your dog house trained? *

YesNoPartly

Where does your dog stay while you are gone?*

Is your dog loud or destructive while you are gone? *

No/yes

If yes, please describe in detail:

Where does your dog sleep at night (dogs may need to be kenneled at night for safety)?*

Emergency Contact Name:*

Emergency Contact Phone:*

By selecting the field below I agree to provide up to date shot records for my dog prior to my first appointment by emailing shot records to LoveDogs@CourteousCanine.com*

I have read and agree to the terms above

ClearSign Here

Please sign using the space above.

In-Home Boarding Intake Form

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