Name *

First Name

Last Name

Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is your dog desexed? *

Yes

No

What is your dog's sex? *

Female

Male

Are your dog's vaccinations up to date? *

Yes

No

Is your dog microchipped? *

Yes

No

Is your dog registered with your local council? *

Yes

No

Does your dog walk off lead often? *

Yes

No

Occasionally

How is your dog's recall? *

Great

Mostly Okay

Needs work

How is your dog's swimming ability? *

Great

Good

Average

Will not swim

Has your dog ever displayed any agression or reactivity? *

Yes

No

In the past

Is your dog nervous around unfamiliar people? *

Yes

No

How does your dog socialise with other dogs? *

No issues with other dogs

Nervous at first but warms up

Doesn't play nice with other dogs

How does your dog go with car travel?

Great

Okay

Not well

Does your dog have any medical conditions? *

Yes

No

Does your dog take any regular medications? *

Yes

No

Has your dog ever attended a day care or dog walk service?

Doggy Day Care

Dog Walk/Adventure Service

Both

None

Are you aware that our dog adventures are OFF LEAD and your dog will be visiting unfenced locations? *

Yes