Training Questionare
Your name:
*
Address:
Email:
*
* Required Field
*
Phone
Cell Phone
Dogs
name
No
Yes


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?
Dogs Age
Breed
Male
 Female
Emergency Contact:
Emergency phone:
Veterinarian:
Vets Phone
Vets Address
Is your dog up to date on their
vaccinations and have a
negative fecal Within the last 6
mon-year?
Yes
No
What kind of food is your dog on?
Is your dog spayed or
neutered?
If Yes, What meds and
when do they need to be
taken?
Is your dog on any
medications?
Yes
 No
Does Heavenly Days have permission
to contact your veterinarian?
Has your dog ever bitten a human? If
yes, please explain:
Has your dog ever bitten another dog?
If yes, please explain:
Is your dog protective of its food? If
yes, please explain:
Is there anything that your dog is afraid of or
makes him/her uncomfortable?
Finish this sentence: My dog does not
like it when...
Finish this sentence: My dog does not
like it when I touch its...
Please describe any behavioral
problems you are concerned with:
What have you done to correct the
problem?
What type of collar have you
used?(pinch,prong,head
harness,harness, easy walk, etc).
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.
*
Please type your name here:
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.
.