Please take your time and complete this form as comprehensively as possible

Owners Full Name:

Address:

Country

City

Zip code

what3words.com: *

Image of Address from Road: *

Max file size 2mb

Email: *

Home Phone Number:

Work Phone Number:

Mobile Phone Number: *

Emergency Contact Number: *

Dog Details

Name:

Breed:

Colour:

Where Obtained:

Breeder

Rescue

Other

If other, please state

Date of Birth:

Owned Since:

Gender:

Male

Female

Neutered: (Please remember all dogs over 6 months old must be neutered to attend Day Care unless previously agreed) *

Yes

Will be when reaches 6 months of age

Vet Details

Vet Name:

Veterinary Practice / Surgery Name:

Veterinary Practice / Surgery Address:

Country

City

Zip code

Veterinary Practice / Surgery Phone:

Veterinary Practice / Surgery Email:

Medical

Microchip Number:

Next Annual Vaccination Due: *

Vaccination Record / Certificate JPG or PNG

Max file size 2mb

Medical History PDF

Max file size 2mb

Last Flea Treatment:

Last Worming Treatment:

Any Recent Veterinary History & Advice Given:

Is Your Dog On Any Medication:

Yes

If Yes, Please Detail Medication

Normal Diet of:

How Often Fed Per Day:

Other Details

Is Your Dog Insured? *

Yes

Insurer

Policy Number

Date Of Renewal

Other Dogs In Household:

Yes

Behaviour With Other Dogs In Household:

Fabulous

Good

Reasonable

Not Good

Behaviour With Other Dogs Outside Household:

Fabulous

Good

Reasonable

Not Good

Behaviour With Owners:

Fabulous

Good

Reasonable

Not Good

Behaviour With Visitors To The House:

Fabulous

Good

Reasonable

Not Good

Behaviour With Strangers Outside The House:

Fabulous

Good

Reasonable

Not Good

Please Describe Your Dogs Personality As Best You Can:

Any Behavioural Problems You Are Aware Of:

Yes

Please Describe Any Behavioural Problems You Are Aware:

How Did You Find Out About Halo Dogs:

Vet Referral

Trainer/Behaviourist Referral

Search Engine TV, Radio, Newspaper Other

Rescue Centre Referral

Friend Referral

Any Other Comments You Would Like to Add:

Tick This Box To Confirm You Accept Our Collection And Drop Off Times Are Between 8-10am & 4-6pm (We do not offer specific collection times) *

Yes

Tick This Box To Confirm You Will Provide Keys If No One Will Be Home (We are fully insured key holders) *

Yes

Tick This Box To Confirm You Have Read And Agreed To Our Terms & Conditions *

Yes

Consents:

Do You Give Consent For Us To Feed Your Dog ? *

Yes

Do You Give Consent For Your Dog To Eat With Other Dogs? *

Yes

If Your Pup is <1yr, Do You Give Consent To Mix With Other Dogs? *

Yes

Do You Give Consent For Your Dog To Be Walked With Other Dogs? *

Yes

Do you give consent for your dog to be off lead? *

Yes

Do You Give Consent For Your Dog To Benefit from Environmental Enrichment? *

Yes

Do You Give Consent For Us To Use Our Vet; Village Vet Potters Bar & Royal Veterinary College? *

Yes

Do You Give Consent For the Use Of A Crate During Transportation? *

Yes

Do You Give Consent For Us To Administer Medicines? *

Yes

Do You Give Consent For Us To Treat Any External Parasites? *

Yes

Do You Give Consent For Us To Provide A Preventative Treatment Under Direction of Our Vet? *

Yes

Do You Give Consent For A Vet to Euthanise Your Dog? *

Yes

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Application Form

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