New Client Application Form

DOG INFORMATION

How many dogs would you like to bring to Whitaker Dog Day Camp? *

Dog Name/s *

Dog Gender *

Male

Female

Breed *

Color & Description *

Dog Birthdate *

Weight *

Name of Veterinarian Clinic *

Spayed/Neutered *

Yes

No

Fully Vaccinated *

Yes

No

*All dogs must have current and completed Rabies, DHPP, Bordetella, Canine Influenza, and Leptospirosis series. Please let us know if your pup is not up to date and you would like assistance getting vaccinations. Click Here for more information.

With Medical Conditions *

Yes

No

With Allergies *

Yes

No

Does your dog have a history of seizures? *

Yes

No

Please indicate if your dog shows any of the following behaviors. Check all that apply. *

Dog Aggressive

Human Aggressive

Fear of Dogs

Overly Protective of Owner

Possessive of food/toy

Humps

Jumps/Climbs Fences

None of the above

Dog Pictures *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Relevant Documents (Vaccines,etc.) *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Is there anything we should know about your dogs? *

CLIENT INFORMATION

Primary Owner First Name *

Primary Owner Last Name *

Phone *

By providing my cell phone number I agree to receive calls and texts to that number from Whitaker Dog day Camp, LLC. Msg & Data Rates May Apply. Text STOP to opt out. Text HELP for more info.

Email *

Instagram Handle *

We'll tag you in videos!

Address

Street Address *

City *

State *

Country *

Country

Postal code *

Secondary Owner First Name

Secondary Owner Last Name

Secondary Owner Phone

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone *

How did you hear about us? *

Promotional Code

SUBMIT