New Customer Enrollment Form 1. Owner Info 2. Pet's Info 3. Pet's Health 4. Pet's Behaviour Spam protection, skip this field Owner Information Title Mr.Mrs.Ms.MissProf.Dr. Full Name Street No. & Name Suburb Home Phone (optional) Mobile Email Name(s) of others who are approved to collect your pet from us (optional) How did you hear about us? Word of mouth Google Website Flyer Other Facebook Instagram GrabOne See Spot Learn Pet's Info Name Breed Sex Male Female Colour Desexed? Yes No Date of Birth (Approximate) Day12345678910111213141516171819202122232425262728293031 MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year2000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039 *Has your dog attended day care before? Yes No *Please note if your dog has been to kennels or attended another dog daycare centre, your dog must not attend our day care for at least 7 days to prevent the possible spread of infections such as canine cough If yes, what was your reason for leaving? (optional) Can you please tell us why you are putting your dog into day care? Looking for more exercise Your active dog loves to play all day Socialisation with other dogs Human company during the day Additional services (boarding/grooming) Has your dog ever been expelled from a day care before? Yes No If yes, please provide details (optional) How often do you require day care? (eg 1, 2, 3, 4 or 5 days a week, 1 or 2 days a month....) Alternative Contact for Emergencies Contact Full Name Contact Number Veterinarian Information Practice Name Practice Phone (optional) Address Dog Health & Medical InfoPlease note all vaccinations must be current to enter our facility.Please also email a photo/scan of your vaccination details to us at email@example.com or you can bring your Pet Passport with you on your first day. Kennel Cough Received on 5 in 1 (DHPPV, Distemper, Parvo etc) Received on .Lepto Virus Received on Flea Treatment Received on .Worming Treatment Received on Does your dog have any medical conditions? (optional) Does your dog have any injuries or joint problems e.g. arthritis, dysplasia? (optional) Does your dog have any allergies / sensitivities? (optional) Does your dog have any recent illnesses? (optional) Does your dog have any ear problems? (optional) Pet's Behaviour Has your dog ever been classified as dangerous or menacing as defined by Auckland Council? Yes No Does your dog display any of the following behaviours? (optional) Excessive barking Shyness or Apprehension Separation anxiety Mounting dogs/people Jumping fences Mouthing/biting Jumping up on people Resource guarding How does your dog react around puppies or high energy dogs? (optional) How does your dog react when approached by other dogs on lead? (optional) Does your dog display fear or anxiety from the following? (optional) Sudden noises Cars, skateboards, wheels & moving objects Certain people Certain situations Thunder, rain or wind Does your dog willingly share toys & balls with other dogs? (please tick) (optional) Toys Balls Does your dog dislike being petted in places? (tail, feet, ears) (optional) What games does your dog enjoy? (chase, ball etc) (optional) Can your dog have treats while in our care? Yes No Training If your dog has attended formal training, please advise what level and style (optional) Is your dog (optional) House trained Crate trained Recall trained Lead trained What cues does your dog know? (optional) Sit Stay Heal Come Off Wait Down Leave Legal Yes I accept The Dog Den Terms and Conditions Acceptance of the Terms and Conditions on The Dog Den Website (defaulted to yes - by clicking on Enrol now you are agreeing to accept T&Cs)You can read the full Terms and conditions here.