Naples Safari Animal Hospital & Pet Resort, Inc.
Enrollment Application for Group Play/Daycare

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FOR OFFICE USE ONLY
Enrollment form_____     Enrollment Fee_____     Shots_____    Staff Screened_____
NOTES:

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EMERGENCY CONTACT INFORMATION

Owner Information
Name:__________________________________________________________________
Address:________________________________________________________________
Email:__________________________________________________________________
Phone:____________________________    Alt. Phone:___________________________

Emergency Contact
Email:__________________________________________________________________
Phone:____________________________    Alt. Phone:___________________________

Pet Information
Name:____________________    Breed:__________________  DOB:_______________
Sex:______________   Neutered/Spayed:________________ Weight:_______________

Veterinarian
Name:__________________________________________________________________
Address:________________________________________________________________
Phone:____________________________               Fax:___________________________

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Pet Personality Profile

How did you hear about Safari Daycare?_______________________________________
Date you acquired dog:_____________________________________________________
At what age was dog spayed/neutered?________________________________________
Where did you get your dog?________________________________________________
If adopted, do you have any knowledge of your dog’s past history?__________________
Does your dog like children?________________________________________________
How does your dog behave around children?____________________________________
Are there other animals in your household?  If so, please list type, sex and age of each:
________________________________________________________________________
How does your dog get along with other resident animals?_________________________
PLEASE USE THE BACK OF  PAGE FOR ADDITIONAL INFORMATION
Health/Grooming   
Does your dog have a problem with fleas?_____________         Allergies?____________
Does your dog have hip dysplasia?________  If yes, what restrictions need to be placed on your dog’s activities or
movements?________________________________________
Does your dog like to be brushed?____________________________________________
How does your dog react to having his/her nails clipped?__________________________
Does your dog have any sensitive areas on his/her body?__________________________
Where are your dog’s favorite petting spots?____________________________________

Behavior
Does your dog act afraid of any specific items or noises?  If so, please explain:
________________________________________________________________________
How does your dog react to strangers coming into your home or yard?
________________________________________________________________________
Does your dog ever bark or growl at anyone passing outside your yard or home?
________________________________________________________________________
Are there kinds of people your dog automatically fears or dislikes?
________________________________________________________________________
Are there any kinds of dogs your dog automatically fears or dislikes?
________________________________________________________________________
How does your pet react to puppies? __________________________________________
Has your dog ever climbed or jumped a fence?__________________________________
Has your dog ever dug under a fence?_________________________________________
Does your dog go to dog parks?____________________________       How did he react?
________________________________________________________________________
Has your dog ever:
Growled at someone?______________________                 What were the circumstances:
________________________________________________________________________
Bitten someone?_______________________                       What were the circumstances:
________________________________________________________________________
Does your dog have any problems in any of the following areas: (if so, please explain)
Mouthiness:_________________________    Housetraining:______________________
Barking:____________________________    Digging:___________________________
Jumping:____________________________   Other:_____________________________
Has your dog ever growled or snapped at anyone who has taken his/her food or toys away from him/her?
____________________________________________________________
What were the circumstances?_______________________________________________
Has your dog shared his/her toys with other animals?_____________________________
Does your dog play with any toys?_____________   If yes, then what kind of toys does your dog like and what games
does he/she play?_________________________________
Does your dog play with other dogs?__________________________________________
Has your dog ever had any formal obedience training?____________________________
If yes, when and where?____________________________________________________
What commands does your dog know?________________________________________
Other comments about your dog which you may feel might be helpful:_______________