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Boarding Questionnaire
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Your name:
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Address:
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Email:
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*
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Phone
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*
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Cell Phone
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* Required Field
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Yes
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No
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Dogs name
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Has your dog been socialized with
other dogs and people?
Is your dog good with kids?
Has your dog ever jumped a fence?
Does your dog dig?
Has your dog been known to chew
or destroy furniture, beds, rugs,
etc.?
Can your dog have treats?
Is your dog micro chipped or
tattooed?
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Dogs Age
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Breed
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Male
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Female
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Emergency Contact:
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Emergency Phone:
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Veterinarian:
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Vets Phone
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Vets Address
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Is your dog up to date on their
vaccinations and have a
negative fecal Within the last 6
mon-year?
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Yes
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No
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Is your dog spayed or neutered?
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What is your dogs
feeding schedule
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AM
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Is your dog on any
medications?
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Noon
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If Yes, What meds and
when do they need to be
taken?
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PM
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Has your dog ever bitten a human? If
yes, please explain:
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Tell us a little about your dog.(Example: He’s
friendly and loves to chase the ball, etc.)
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Has your dog ever bitten another dog?
If yes, please explain:
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Finish this sentence: My dog does not
like it when...
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Is your dog protective of its food? If
yes, please explain:
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Finish this sentence: My dog does not
like it when I touch its...
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No
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Yes
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Does Heavenly Days have permission
to contact your veterinarian?
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In consideration of my admission to boarding, I release Heavenly Days Anne Schiller, and its agents from any
actions, claims, or demands for any personal injury to my dog or myself, which may arise out of my participation in
Heavenly days. I understand that there are inherent risks to boarding dogs and entering an environment with other
dogs. I assume all risk to myself, children, guests, dog and their property. I shall indemnify and Hold Harmless
Heavenly Days, Anne Schiller, and its agents against any physical harm or property loss/damage during and after
boarding is completed.
I would like to assure you that your dog will be treated as I would treat my own dogs, and that every safety
precaution will be taken to insure the well being of your dog. Unfortunately death or unforeseen injuries could
occur. By signing this agreement you agree that Heavenly Days, and its agents, Anne Schiller, or any member of
her family will not be held responsible for injury or death of the dog. Heavenly Days, Anne Schiller, and its agents
reserve the right to deny or dismiss dog from the facility if deemed necessary.
The Hold Harmless Agreement shall remain in effect for the duration of your dogs visit as well as be applicable for
future visits with Heavenly Days.
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*
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Please type your name here:
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By typing my name on this application, I acknowledge that I have read the Boarding Release and Hold
Harmless Agreement and I agree to it's terms.
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