Helping you enjoy a lifetime
of happiness with your dog!

Doggie Daycare Application (New Dogs Only)

This application is for new doggie daycare dogs only. If you are an existing daycare dog, use the express sign-up form.

All new dogs are required to visit us for an interview prior to their first day in daycare.

Full Name*	Must be over 12 years old
Street address1
Street address2
City
	State Zip Code

Home phone*
Work phone
Cell phone
Email address*

Spouse/partner name

Emergency Contact Name
Daytime Phone
Evening Phone
How did you hear about Gemini Dogs?	Other:

Name*
Breed*
Sex	Male Female
Is your dog spayed or neutered?	Yes No Note: You must spay/neuter your dog by the age of 6 months to continue in daycare.
Age*
Birth date	(mm/dd/yyyy)
Weight	(lb)
Is your dog friendly toward other dogs?*
Is your dog friendly toward other people?*
Why are you enrolling in doggie daycare?
Have you (or are you) enrolled in classes with this dog at Gemini Dogs?*

Where did you obtain your dog? Be as specific as possible.
How old was your dog when you got him?
Is this your first dog?	Yes No
What brand of food do you feed your dog?
How much do you feed your dog each meal?
When do you feed your dog?	Breakfast Lunch	Dinner Leave out all day
Are you using a crate at home?	Yes No
Is your dog housetrained?	Yes No

What does your dog do when you:	Take toys away from him Approach him when he is eating Touch his neck or collar Touch him when he is sleeping

Name of your animal hospital or vet office (not your vet's name)
	Note: You do not have to provide us with copies of your dog's vaccination records. We will contact your vet directly.
Tattoo Number
Microchip Number
Describe any physical problems, illness, skin problem, or other condition that your dog has.
	Note: Include any issues with blindness, deafness, epilepsy, arthritis, and hip/joint problems.
What medication is your dog currently taking?*
What are your dog's dietary restrictions and/or allergies?*
Is your dog afraid of anything (for example thunder, loud noises, fireworks)?*
Is there anything else that you feel we should know about your dog?

Day*
Date*
Would you like to pay by credit card?	Yes No
Promo code

We will contact you to confirm that the date you entered above is available and that your dog has been accepted in our daycare program.

Note: All new dogs are required to visit us for an interview prior to their first day in daycare.

Type your name in the box to indicate your acceptance of the waiver.*