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STOP IN TODAY ➤ 6346 FARM BUREAU ROAD ALLENTOWN, PA 18106
0
Daycare and Boarding Enrollment Form
Step 1 of 5 - General Owner Information
20%
Owners
*
First Name
Last Name
Address
*
Street Address
City
State
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Contact Name:
*
Primary Contact Phone Number:
*
Secondary Contact Name:
Secondary Contact Phone Number:
Email
*
Emergency Contact(s) (Not in Same Household)
*
Name
Phone
Relationship
Approved Person(s) for Pick Ups/Drop Offs: (Not in Same Household)
Name
Phone
Relationship
Dog’s Name
*
Dog's Breed
*
Dog's Color
*
Dog's Weight
*
Dog's Gender
*
Choose Gender
Male
Female
Dog's Birth Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
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5
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28
29
30
31
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Fixed (Neutered/Spayed) *REQUIRED FOR DAYCARE IF OVER 6 MONTHS*
*
Yes
No
Fixing (Spaying/Neutering) Appointment Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
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
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Veterinary Clinic
*
Referral
*
How did you hear about Leader of the Pack?
Friend / Family referral
Vet Office
Internet Search
Radio Advertisment
Newspapers
Facebook
Sign
Magazine
Bill board
Other
Please describe how you heard about us.
*
Dog License
Number
County
Microchip
Microchip Number
Brand
Yearly Heartworm Test?
*
Yes
No
Flea and Tick Medication?
*
Yes
No
Describe any medical/health issues we need to be aware of: (i.e. seizures, heart/hip problems, etc.)
*
Please list any known allergies that your dog has:
*
Please list any medications your dog is currently taking:
Select the items that you will provide to assist our staff when administering your pets medications:
*
Select All
Peanut Butter
Pill Pockets
Cheese Slices
Deli Meats
Canned Dog Food
*Please be sure to bring only enough medications for your pets stay. At check-in, please be specific when explaining your pets medication schedules and be sure to mention any sensitivities or allergies they may have. Thank you!
How long has your dog been in your family?
*
Where did you get your dog?
Is Your Dog Adopted?
*
Yes
No
Past History (If Known)
*
Has your dog had any obedience training?
*
Yes
No
Obedience Training Level
*
Beginner
Advanced
CGC
TDI
Agility
Has your dog ever been enrolled in daycare before?
*
Yes
No
If yes, where?
Do you use a crate?
*
Yes
No
Are they comfortable in the crate?
*
Yes
No
Is your dog comfortable with having his/her feet touched?
*
Yes
No
I'm not sure
Is your dog comfortable with having his/her collar used to lead?
*
Yes
No
I'm not sure
Has your dog ever climbed or jumped a fence?
*
Yes
No
I'm not sure
Has your dog ever growled or snapped at anyone who’s touched his/her bones, food or toys?
*
Yes
No
I'm not sure
Does your dog play with other dogs on a regular basis?
*
Yes
No
Would you say he/she plays nicely?
*
Yes
No
Would you say he/she plays nicely? (Cont.)
Does your dog prefer certain sexes of dogs?
*
Yes
No
Which sex?
*
Male
Female
Does your dog automatically dislike any kind of dog?
*
Yes
No
What kinds?
*
How does your dog react to puppies?
*
Happy to see them
Go away I don’t like you
Indifferent to them
How does your dog react to strangers?
*
Happy to see them
Go away I don’t like you
Indifferent to them
Does your dog automatically dislike any kind of person?
*
Yes
No
What kinds?
*
Describe any behavioral problems/idiosyncrasies/special sensitivities we should be aware of
*
IF ANY OF THE ABOVE INFORMATION CHANGES, PLEASE NOTIFY US IMMEDIATELY!
Rules And Regulations Form
*
I Have Read The Rules And Regulations
Client Agreement Form
*
I Have Read The Client Agreement
Waiver And Release Form
*
I Have Read The Waiver And Release Form
Signature (Signee acknowledges all forms have been read and agreed upon, Signee be at least 18 years of age)
*
Upload vaccination records below:
Drop files here or
Upload your dog's picture below:
Drop files here or
Section Break
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First Choice
Second Choice
Third Choice
If you wish to print and scan the enrollment form instead, you can access the PDF versions here:
Step 1 of 5 - General Owner Information
20%
Owners
*
First Name
Last Name
Address
*
Street Address
City
State
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Contact Name:
*
Primary Contact Phone Number:
*
Secondary Contact Name:
Secondary Contact Phone Number:
Email
*
Emergency Contact(s) (Not in Same Household)
*
Name
Phone
Relationship
Approved Person(s) for Pick Ups/Drop Offs: (Not in Same Household)
Name
Phone
Relationship
Dog’s Name
*
Dog's Breed
*
Dog's Color
*
Dog's Weight
*
Dog's Gender
*
Choose Gender
Male
Female
Dog's Birth Date
*
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
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
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Fixed (Neutered/Spayed) *REQUIRED FOR DAYCARE IF OVER 6 MONTHS*
*
Yes
No
Fixing (Spaying/Neutering) Appointment Date
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
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
Year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Veterinary Clinic
*
Referral
*
How did you hear about Leader of the Pack?
Friend / Family referral
Vet Office
Internet Search
Radio Advertisment
Newspapers
Facebook
Sign
Magazine
Bill board
Other
Please describe how you heard about us.
*
Dog License
Number
County
Microchip
Microchip Number
Brand
Yearly Heartworm Test?
*
Yes
No
Flea and Tick Medication?
*
Yes
No
Describe any medical/health issues we need to be aware of: (i.e. seizures, heart/hip problems, etc.)
*
Please list any known allergies that your dog has:
*
Please list any medications your dog is currently taking:
Select the items that you will provide to assist our staff when administering your pets medications:
*
Select All
Peanut Butter
Pill Pockets
Cheese Slices
Deli Meats
Canned Dog Food
*Please be sure to bring only enough medications for your pets stay. At check-in, please be specific when explaining your pets medication schedules and be sure to mention any sensitivities or allergies they may have. Thank you!
How long has your dog been in your family?
*
Where did you get your dog?
Is Your Dog Adopted?
*
Yes
No
Past History (If Known)
*
Has your dog had any obedience training?
*
Yes
No
Obedience Training Level
*
Beginner
Advanced
CGC
TDI
Agility
Has your dog ever been enrolled in daycare before?
*
Yes
No
If yes, where?
Do you use a crate?
*
Yes
No
Are they comfortable in the crate?
*
Yes
No
Is your dog comfortable with having his/her feet touched?
*
Yes
No
I'm not sure
Is your dog comfortable with having his/her collar used to lead?
*
Yes
No
I'm not sure
Has your dog ever climbed or jumped a fence?
*
Yes
No
I'm not sure
Has your dog ever growled or snapped at anyone who’s touched his/her bones, food or toys?
*
Yes
No
I'm not sure
Does your dog play with other dogs on a regular basis?
*
Yes
No
Would you say he/she plays nicely?
*
Yes
No
Would you say he/she plays nicely? (Cont.)
Does your dog prefer certain sexes of dogs?
*
Yes
No
Which sex?
*
Male
Female
Does your dog automatically dislike any kind of dog?
*
Yes
No
What kinds?
*
How does your dog react to puppies?
*
Happy to see them
Go away I don’t like you
Indifferent to them
How does your dog react to strangers?
*
Happy to see them
Go away I don’t like you
Indifferent to them
Does your dog automatically dislike any kind of person?
*
Yes
No
What kinds?
*
Describe any behavioral problems/idiosyncrasies/special sensitivities we should be aware of
*
IF ANY OF THE ABOVE INFORMATION CHANGES, PLEASE NOTIFY US IMMEDIATELY!
Rules And Regulations Form
*
I Have Read The Rules And Regulations
Client Agreement Form
*
I Have Read The Client Agreement
Waiver And Release Form
*
I Have Read The Waiver And Release Form
Signature (Signee acknowledges all forms have been read and agreed upon, Signee be at least 18 years of age)
*
Upload vaccination records below:
Drop files here or
Upload your dog's picture below:
Drop files here or
Section Break
CAPTCHA
Untitled
First Choice
Second Choice
Third Choice
Daycare/Boarding Enrollment Form
Daycare/Boarding Rules & Regulations Form
Daycare/Boarding Client Agreement Form
Daycare/Boarding Waiver and Release Form
