Canine Camper Application

Please keep in mind the following holidays when making your reservation: New Year’s Day, Easter, Memorial Day, July 4th, Labor Day, Thanksgiving Day, Christmas Day. While our animal care staff will be operating as normal, business offices are closed and guests will be unable to check in or out on those holidays.

Initial Canine Camper Application

Welcome to The Lodge Luxury Boarding Retreat! We are excited that you considering The Lodge for doggy daycare and boarding for your pup, or as we like to say, your “Camper.” Please complete this application to the best of your knowledge and make sure you read and understand the attached policies, release and waiver. You will only need to fill out this application one time to set your camper up for boarding/lodging with The Lodge. Updates can be sent by using our Short Form.

- Step 1 of 12

PARENT'S INFORMATION

Parent's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone *

Work Phone

Cell Phone *

CAMPER'S INFORMATION

Camper's Name *

Birthdate/Age *

Weight

lbs

Breed *

Color *

Sex *

Male
Female

Spayed/Neutered *

(Required at 8+ months)

Veterinarian Hospital *

Vet Phone Number

Do we have your permission to send your records to any other Veterinary Facility or Boarding Facility?

Yes
No
Call me first

ADDITIONAL PETS LIVING WITH YOUR CAMPER

Do you have additional pets living with your camper? If so, how many? *

Name - Pet 1

Breed

Sex

Male
Female

Age

Name - Pet 2

Breed

Sex

Male
Female

Age

Name - Pet 3

Breed

Sex

Male
Female

Age

VACCINATIONS & OTHER REQUIREMENTS

Guardian/Owner is required to provided veterinary proof of current and updated Rabies, Distemper-parvo and Bordetella. Proof of a current NEGATIVE Intestinal Parasite Exam.

CAMPERS PAST MEDICAL HISTORY

Does your Camper have any of the following?

Heart Condition
Thyroid Disease
Allergies
Seizures*
Physical Limitations**
Cushing's Disease
Cancer
Other***
None of the Above

If yes to any of the above conditions, please explain:

Seizures* - Please describe frequency, severity, cause of occurrence, behaviors to look for, etc.
Physical Limitations - Arthritis, Missing Limb, Blind, Deaf, etc.
Other* - Please describe

EMERGENCY CONTACT (SOMEONE OTHER THAN YOURSELF)

Emergency Contact Name *

Relationship *

Home Phone

Work Phone

Cell Phone *

LEARNING MORE ABOUT YOU AND YOUR CAMPER'S NEEDS

How did you first hear about the Lodge? *

Drive-By
Social Media
Newspaper
Event
Email
Referral
Search Engine
Other

Referral Name (if applicable)

Other

Have you ever used doggy day/boarding services at another facility? *

If yes, please list the names of such businesses:

Have you visited The Lodge Luxury Boarding Retreat/Animal Hospital of Montgomery before? *

What are the primary reasons for bringing your Camper to camp? *

Camper loves to play
I don't like to leave my Camper alone all day
I travel extensively
I work long hours
Camper needs a lot of exercise
Camper needs a vacation
Recommendation of trainer or other person
Camper gets lonely
Camper exhibits destructive behaviors
Other

Which services are you looking for? *

Daycare
Boarding
Training
Bathing/Nail Clipping

Are there any other services you would like for The Lodge to offer in the future?

GETTING TO KNOW YOUR CAMPER

Does your Camper engage in any unusual repetitive behavior? *

If yes, please explain

Does your Camper have any destructive behavior? *

If yes, please explain

Check all that describes your Camper's personality: *

Outgoing
Sensitive
Pushy
Reserved
Aggressive
Playful
Talkative
Affectionate
Chewer
Snuggler
Growler
Mouthy
Afraid of Storms
Timid
Biter
Protective
Happy
Afraid of Men
Friendly
Fearful
Other

Other personality descriptions:

If your Camper has any fears, what soothes him/her?

Where is the favorite spot on their body to be pet?

What are their favorite treats?

What are your Camper's favorite play activities? (Check all that apply)

Playing Fetch
Tennis Ball
Tug O' War
Frisbee
Walks
Socializing with People
Snuggling
Playing with other dogs
Other

Other favorite play activities:

Is your Camper Microchipped? *

Check all that describes situations where your pet may become unfriendly: *

Grabbing Collar
Loud Noises
Petting
Touching Paws
Removing Food
Touching Ears
Touching Tail
Touching While Sleeping
Taking Away Toys
Being Around Strange Dogs
Belly Rubs
Baths
None of the above

Other situations:

Check all behaviors (if any) that apply to your Camper that we need to know about: *

Snaps
Barks
Growls
Bares Teeth
Freezes
Hides
Runs Away
Backs Away
May Bite
Will Bite
Trembles
None of the above

Other behaviors:

CANINE BEHAVIOR

Where did you get your Camper and how long has he/she been in the family?

Is there any PERSON, type of DOG, or SITUATION your Camper seems to be uncomfortable with? *

If yes, please describe

Has your Camper ever growled at or bit another PERSON or DOG? *

If yes, what were the circumstances?

Can you take a food item away from your Camper without him/her growling? *

Will your Camper readily share toys with other dogs? *

If no, please describe

Has your Camper ever jumped a fence or barrier? *

Are there areas on your Camper's body where he/she DOES NOT like to be touched by humans? *

If yes, where?

Has your Camper ever been socialized with a large group of dogs (8 or more)? *

If yes, please describe their experience:

Does your Camper play well with dogs of all sizes? *

If no, please describe:

Is your Camper afraid of thunderstorms? *

If yes, how do we make him/her feel comfortable?

Are there any restrictions that should be placed on your Camper's activities? *

If yes, which activities?

Please list person(s) authorized to drop off and/or pick up your Camper(s):

Please use commas between your person(s) listed.

Is there anything else we should know about your Camper?

PAWLICY AGREEMENT

REQUIRED: I give The Lodge Luxury Boarding Retreat permission to care for my Camper during my departure. I have answered the Camper Application to the best of my knowledge. All my Campers vaccinations (Bordetella, Distemper-Parvo, Rabies), are up-to-date and all past medical history is presented above. A current NEGATIVE Intestinal Parasite exam also. If vaccines are NOT up-to-date, Animal Hospital of Montgomery and The Lodge has my permission to perform such vaccinations and/or an intestinal parasite exam at my expense. If your Camper has never been examined by Animal Hospital of Montgomery, an exam fee of $55.00, plus any additional medical services, will be charged. The Lodge has my permission to do what is necessary should an emergency arise. I acknowledge that The Lodge will exercise all necessary care and precautions to keep my Camper and other participates safe during boarding, daycare, training, and grooming to prevent injury to any person, property, or dog. However, I understand, that because dogs are unpredictable animals with their own will and drives, The Lodge cannot protect against every potential injury, risk, or accident. In addition, I acknowledge that The Lodge is not responsible for personal belongings being lost, damaged, or destroyed during my Campers stay. *

Yes, I agree
No, I do NOT agree

Please type your name below for PAWLICY AGREEMENT. Your signature will be required in the office. *

FLEA TREATMENT/EXTERNAL PARASITE POLICY

REQUIRED: I give The Lodge Luxury Boarding Retreat permission to administer a 24-hour chewy flea treatment (Advantus™) upon arrival for boarding, daycare, and grooming at a cost of $3.00. This treatment will not affect ANY monthly heartworm/flea preventatives. If external parasites are seen, treatment will be given. *

Yes, I give permission
No, I do NOT give permission

Please type your name below for FLEA TREATMENT/EXTERNAL PARASITE statement. Your signature will be required in the office. *

MEDIA OPTION

OPTIONAL: I give The Lodge Luxury Boarding Retreat permission to take and use: photographs and/or digital images of my Camper(s) for use in publicity, illustration, advertising, and web content. I further agree that my name and identity will not be revealed and descriptive text or commentary in connection with the image(s). I authorize the use of these image(s) without compensation to me. *

Yes, I give permission for media
No, I do NOT give permission

Please type your name below for OPTIONAL MEDIA statement. Your signature will be requested in the office.

You are ready to submit your Camper Application!

We will review at the office and print your responses to review with you and obtain signatures where needed.

Message

Canine Camper Application

PARENT'S INFORMATION

CAMPER'S INFORMATION

ADDITIONAL PETS LIVING WITH YOUR CAMPER

VACCINATIONS & OTHER REQUIREMENTS

Guardian/Owner is required to provided veterinary proof of current and updated Rabies, Distemper-parvo and Bordetella. Proof of a current NEGATIVE Intestinal Parasite Exam.

CAMPERS PAST MEDICAL HISTORY

Seizures* - Please describe frequency, severity, cause of occurrence, behaviors to look for, etc. Physical Limitations** - Arthritis, Missing Limb, Blind, Deaf, etc. Other*** - Please describe

EMERGENCY CONTACT (SOMEONE OTHER THAN YOURSELF)

LEARNING MORE ABOUT YOU AND YOUR CAMPER'S NEEDS

GETTING TO KNOW YOUR CAMPER

CANINE BEHAVIOR

PAWLICY AGREEMENT

FLEA TREATMENT/EXTERNAL PARASITE POLICY

MEDIA OPTION

You are ready to submit your Camper Application!

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Seizures* - Please describe frequency, severity, cause of occurrence, behaviors to look for, etc.
Physical Limitations - Arthritis, Missing Limb, Blind, Deaf, etc.
Other* - Please describe