Check-in date
January
February
March
April
May
June
July
August
September
October
November
December
1
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31
Check-out date
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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17
18
19
20
21
22
23
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30
31
Your name
Daytime Phone Number
Evening Phone Number
Mobile Phone Number
Address
City
State
select one
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Email Address
In case of an emergency, please provide two local contacts authorized to pick up your dog. If we are unable to reach your contacts, this form authorizes Canine Corral to approve of any necessary, immediate veterinary care at the owners expense.
Emergency Contact #1
Phone Number
Emergency Contact #2
Phone Number
Veterinarian's Name
Phone Number
Medicine 1
Condition treated
Dispensing instructions
Medicine 2
Condition treated
Dispensing instructions
Medicine 3
Condition treated
Dispensing instructions
My dog is allergic to:
Is it okay for your dog to receive our complimentary treats?
Yes
No
Special instructions for treats
We normally feed dogs twice daily (morning and night). Please indicate any special feeding needs or instructions here
Dog's Name
Dog's Breed
Affenpinscher
Afghan Hound
Aidi
Ainu Dog
Airedale Terrier
Akbash Dog
Akita
Alapaha Blue Blood Bulldog
Alaskan Malamute
Alpine Dachsbracke
American Bulldog
American Eskimo
American Foxhound
American Hairless Terrier
American Pit Bull Terrier
American Staffordshire Terrier
American Toy Terrier
American Water Spaniel
Anatolian Shepherd Dog
Anglo-Francais De Petit Venerie
Anglo-Francasis de Moyen Venerie
Appenzell Mountain Dog
Ariege Pointer
Ariegeois
Armant
Aryan Molossus
Australian Cattle Dog
Australian Greyhound
Australian Kelpie
Australian Shepherd Dog
Australian Terrier
Austrian Brandlbracke
Austrian Pinscher
Auvergne Pointer
Azawakh
Balkan Hound
Barbet
Basenji
Basset Artesian Normand
Basset Blue De Gascogne
Basset Fauve de Bretgne
Basset Hound
Bavarian Mountain Hound
Beagle
Beagle Harrier
Bearded Collie
Beauceron
Bedlington Terrier
Belgian Griffon
Belgian Mazstiff
Belgian Sheepdog , Laekenois
Belgian Sheepdog, Groenendael
Belgian Sheepdog, Malinois
Belgian Sheepdog, Tervuren
Belgian Shorthaired Pointer
Bergamasco
Berger De Beauce
Berger De Picard
Berger Du Languedoc
Berner Lufhund
Bernese Mountain Dog
Bichon Frise
Billy
Black and Tan Coonhound
Black Forest Hound
Black Norwegian Elkhound
Bloodhound
Blue Picardy Spaniel
Bluetick Coonhound
Bolognese
Border Collie
Border Terrier
Borzoi
Bosnian Rough-Coated Hound
Boston Terrier
Bourbonnais Pointer
Bouvier des Flandres
Boxer
Bracco Italiano
Braque St. Germain
Brazilian Mastiff
Briard
Briquet Griffon Vendeen
Brittany
Bruno Jura Laufhund
Brussels Griffon
Bull Boxer
Bull Terrier
Bulldog
Bullmastiff
Ca De Bestiar
Ca De Bou
Cairn Terrier
Canaan Dog
Canary Dog
Cane Corso
Cardigan Welsh Corgi
Carolina Dog
Catahoula Leopard Dog
Catalan Sheepdog
Cavalier King Charles Spaniel
Central Asian Sheepdog
Chein d'Artois
Chesapeake Bay Retriever
Chihuahua
Chinese Crested
Chinese Shar Pei
Chinook
Chow Chow
Cirneco Dell'Etna
Clumber Spaniel
Cocker Spaniel
Cockerpoo
Collie
Corded Poodle
Coton De Tulear
Croatian Sheepdog
Curly Coated Retriever
Czech Wolfdog
Czesky Fousek
Czesky Terrier
Dachshund
Dalmatian
Dandie Dinmont Terrier
Deerhound
Dingo
Doberman
Dogo Argentino
Dogue de Bordeaux
Drentse Patrijshond
Drever
Dunker
Dutch Partridge Dog
Dutch Sheepdog
Dutch Shepherd Dog
Dutch Smoushond
East Siberian Laika
English Cocker Spaniel
English Coonhound
English Foxhound
English Setter
English Springer Spaniel
English Toy Spaniel
English Toy Terrier
Entelbuch Mountain dog
Epagneul Bleu De Picardie
Epagneul Pont-Audemer
Estrela Mountain Dog
Eurasier
Field Spaniel
Finnish Hound
Finnish Lapphund
Finnish Spitz
Flat-Coated Retriever
French Bulldog
French Gascony Pointer
French Pyrenean Pointer
French Spaniel
German Hunting Terrier
German Pinscher
German Shepherd Dog
German Shorthaired Pointer
German Spaniel
German Spitz
German Spitz Toy
German Spitz: Giant
German Wirehaired Pointer
German Wolfspitz
Giant Schnauzer
Glen of Imaal Terriers
Golden Retriever
Gordon Setter
Grand Anglo-Francais
Grand Anglo-Francais Blanc Et Noir
Grand Basset Griffon Vendeen
Grand Bleu De Gascogne
Grand Gascon-Saintongeois
Grand Griffon Veneen
Great Dane
Great Pyreneens
Greater Swiss Mountain Dog
Greenland Dog
Greyhound
Griffon Fauve De Bretagne
Griffon Niveranis
Haldenstovare
Hamiltonstovare
Hanoverian Mountain Hound
Harrier
Havanese
Hovawart
Hungarian Greyhound
Hungarian Vizsla
Hygenhund
Ibizan Hound
Iceland Dog
Illyrian Sheepdog
Inca Hairless Dog
Irish Red-And-White Terrier
Irish Setter
Irish Terrier
Irish Water Spaniel
Irish Wolfhound
Istrian Rough-Coated Hound
Istrian Shepherd
Istrian Smooth-Coated Hound
Italian Greyhound
Italian Hound
Italian Spinone
Jack Russell Terrier
Japanese Chin
Japanese Spitz
Japanese Terrier
Jindo
Kai Dog
Karelian Bear Dog
Keeshond
Kerry Beagle
Kerry Blue Terrier
Komondor
Kooiker Dog
Kromforhrlander
Kuvasz
Kyi Leo
Labradoodle
Labrador Retriever
Laekenois
Lakeland Terrier
Lancashire Heeler
Landseer
Lapponian Herder
Large French Pointer
Large Munsterlander
Leonberger
Lhasa Apso
Lowchen
Lpinporokoira
Lucas Terrier
Lundehund
Lurcher
Luzerner Laufhund
Maltese
Manchester Terrier
Maremma Sheepdog
Mastiff
Miniature Bull Terrier
Miniature Dachshund
Miniature Mexican Hairless
Miniature Pinscher
Miniature Poodle
Miniature Schnauzer
Mudi
Neapolitan Mastif
New Guinea Singing Dog
New Zealand Huntaway
Newfoundland
Niederlaufhunds
Nordic Spitz
Norfolk Terrier
Norrbottenspets
North American Shepherd
Norwegian Buhund
Norwegian Elkhound
Norwich Terrier
Nova Scotia Duck Tolling Retriever
Old Danish Pointer
Old English Sheepdog
Olde English Bulldogge
Otterhound
Owczarek Podhalanski
Papillon
Parson Jack Russell Terrier
Patterdale Terrier
Peekepoo
Pekingese
Pembroke Welsh Corgi
Perdguero De Burgos
Perdiguero Portugueso
Perro De Pastor Mallorquin
Peruvian Inca Orchid
Petit Basset Griffon Vendeen
Petit Bleu De Gascogne
Petit Bradancon
Petit Griffon De Gascogne
Phalene
Pharoah Hound
Picardy Shepherd
Picardy Spaniel
Planinsky Gonic
Plott Hound
Podengo Portugueso Medio
Podengo Portugueso Pequeno
Pointer
Poitevin
Polish Hound
Polish Lowland Sheepdog
Pomeranian
Porcelaine
Portuguese Cattle Dog
Portuguese Pointer
Portuguese Shepherd Dog
Portuguese Watchdog
Portuguese Water Dog
Posavac Hound
Prazsky Krysavik
Pudelpointer
Pug
Puli
Pumi
Pyrenean Mastiff
Pyrenean Sheepdog
Rafeiro Do Alentejo
Rampur Greyhound
Redbone Coonhound
Rhodesian Ridgeback
Rottweiler
Russo-European Laika
Saarloos Wolfhound
Sabueso Espanol
Saint Bernard
Saint-Germain Pointer
Saluki
Samoyed
Schapendoes
Schillerstovare
Schipperke
Schwyzer Laufhund
Schwyzer Neiderlaufhunds
Scottish Deerhound
Scottish Terrier
Sealyham Terrier
Segugio Italiano
Shetland Sheepdog
Shiba Inu
Shih Tzu
Shikoku
Shiloh Shepherd
Siberian Husky
Silky Terrier
Skye Terrier
Sloughi
Slovensky Kuvac
Smalandsstovare
Small Munsterlander
Smooth Fox Terrier
Soft-Coated Wheaten Terrier
South Russian Sheepdog
Spanish Greyhound
Spanish Mastiff
Spanish Pointer
Spanish Water Dog
Spinone
St. Hubert Jura Laufhund
Stabyhoun
Staffordshire Bull Terrier
Standard Mancester Terrier
Standard Mexican Hairless
Standard Poodle
Standard Schnauzer
Styrian Rough-Haired Mountain Hound
Sussex Spaniel
Swedish Elkhound
Swedish Lapphund
Swedish Vallhund
Tatra Mountain Sheepdog
Tervuren
Thai Ridgeback
Tibetan Kyi Apso
Tibetan Mastiff
Tibetan Spaniel
Tibetan Terrier
Tosa Inu
Toy American Eskimo
Toy Manchester Terrier
Toy Mexican Hairless
Toy Poodle
Transylvanian Hound
Treeing Walker Coonhound
Vizsla
Volpino Italiano
Weimaraner
Welsh Springer Spaniel
Welsh Terrier
West Highland White Terrier
West Siberian Laika
Wetterhound
Whippet
Wire Fox Terrier
Wire-Haired Pointing Griffon
Wire-Haired Vizsla
Wirehaired Pointer Griffon
Yorkshire Terrier
Yugoslavian Mountain Hound
Yugoslavian Tricolored Hound
Color
Black
Select one
Brown
Rust
Blonde
Blue
Gray
Tan
Orange
White
Brindle
Weight
pounds
Dog's Age
0
1
2
3
4
5
6
7
8
9
10
11 +
years
0
1
2
3
4
5
6
7
8
9
10
11
months
Dog's Birthday
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Dog's Sex
Male
Female
Spayed or Neutered?
Select One
Yes
No
If 'yes', at what age?
0
1
2
3
4
5
6
7
8
9
10
11 +
years
0
1
2
3
4
5
6
7
8
9
10
11
months
Have a tracking microchip?
Yes
Select one
No
Primary veterinarian
Address
City
State
select one
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone Number
Vaccinations
Date last given:
Bortadella
January
February
March
April
May
June
July
August
September
October
November
December
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
Rabies
January
February
March
April
May
June
July
August
September
October
November
December
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
DHLPP
January
February
March
April
May
June
July
August
September
October
November
December
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
How long have you owned your dog?
Select one
Less than 1 year
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10+ years
How did you acquire your dog?
Select one
Breeder
Adopted
Pet store
Gift
Inherited
Stray
If adopted, please describe your dog's history
Number of adults in household
0
1
2
3
4
5+
male
0
1
2
3
4
5+
female
Number of children in household
0
1
2
3
4
5+
ages
Does your dog share a home with other dogs?
Select one
Yes
No
If yes, how many?
0
1
2
3
4
5+
Are they all spayed or neutered?
Select one
Yes
No
Sex of other dogs
0
1
2
3
4
5+
males
0
1
2
3
4
5+
females
Breeds of other dogs
Ages of other dogs
Please list any additional animals at home
Briefly describe how your dog gets along with other
animals at home
Does your dog have any health considerations?
Select one
Yes
No
If so, what are they?
Describe any restrictions on your dog's activities
List allergies
List any medications and what they are for
Is your dog on a flea and tick prevention program?
Select one
Yes
No
Is your dog on a heartworm program?
Select one
Yes
No
Describe your dog reaction to nail clipping
Describe your dog reaction to brushing
Are there areas on the body your dog does not like to
be touched?
Are there areas on the body your dog especially likes
to be petted?
Is your dog easily handled by you?
Select one
Yes
No
Is your dog easily handled by others (vet/groomer)?
Select one
Yes
No
Briefly describe your dog's exercise regimen
Briefly describe your dog's activity level
Has your dog attended daycare before?
Select one
Yes
No
If so, where?
Describe your dog's personality
Is your dog sound sensitive to any noises?
Has your dog ever climbed or jumped over a fence?
Select one
Yes
No
Does your dog exhibit signs of separation anxiety?
Select one
Yes
No
Favorite treat
Favorite toy
Favorite activity
How does your dog react when you take away
toys, food or bones?
How does your dog react when others take away
toys, food or bones?
How often does your dog socialize with other people?
Describe how your dog reacts to visitors in your home
Describe how your dog reacts to other people while on
leash
Has your dog ever growled at someone?
Select one
Yes
No
If so, what were the circumstances
Has your dog ever bitten someone?
Select one
Yes
No
If so, what were the circumstances
Describe any kinds of people your dog automatically
fears or dislikes (tall people, people wearing hats)
Describe anything that makes your dog frightened or
nervous
Do visitors bring their dogs to your home?
Select one
Yes
No
If so, what is your dog's response
How often does your dog socialize with other dogs
Does your dog participate in off-leash play with other
dogs?
Select one
Yes
No
If so, where and how often
Describe how your dog reacts to other dogs while on
leash
Describe how your dog reacts to other dogs while off
leash
Describe how your dog reacts with puppies
Describe how your dog reacts with small dogs
Describe how your dog reacts with big dogs
Describe how your dog reacts with older dogs
Describe any sizes / breeds of dogs your dog
automatically dislikes
What kind of games does your dog play with other dogs?
(chase, tug, wrestle, etc.)
Has your dog shared food or toys with another dog?
Select one
Yes
No
Does your dog prefer to play with female dogs or
males?
Select one
Prefers males
Prefers females
No preference
Has your dog ever bitten another dog?
Select one
Yes
No
If so, what were the circumstances
What was the extent of the damage
to the other dog?
Is your dog crate trained?
Select one
Yes
No
What does your dog do when you are not home?
Has your dog received any formal obedience training?
Select one
Yes
No
If so, when and where
List the obedience commands your dog knows
Dog's potty command
Dog's quiet command
Does your dog have a problem with:
How did you learn about us?
Select one
Web search
Took dog training classes here
Yellow pages
Referred by friend
Referred by veterinarian
Drove/walked past
Other: