Northwood Animal Hospital Doggie Day Camp Application
Please complete and submit our Doggie Day Camp Application. This application is required for entrance into our DDC program and must be received by our office at least four business days prior to your pet's scheduled evaluation day.

Thank You for choosing NAH Doggie Day Camp!
Northwood Animal Hospital DDC program is only available to dogs who are NAH clients/patients and are seen by our medical team yearly for their veterinary needs such as wellness exams, vaccines and testing.

**Re-evaluation is required if no participation for 6 months or more**

Owner(s) Name(s): *

Owner(s) Phone Number(s) *

Email *

Additional Email(s) *

Emergency Contact Full Name *

First

Last

Emergency Contact Phone Number *

Comments/Misc. Notes *

Dog's Information

Dog's Name *

Dog's Gender *

Male
Female

Breed *

Dog's Birthday/Age *

Is your Dog Spayed or Neutered? *

Yes
No

Current Medical History

Name/Brand of flea & tick prevention your dog is on? When do you give it? *

Name/Brand of heartworm prevention your dog is on? When do you give it? *

At what age was your dog spayed or neutered? *

List any allergies your dog has: *

List any medical diagnoses and/or surgeries and their respective dates performed: *

List any medications your dog is on: *

List any special instructions and/or restrictions for your dog (for example: leashing around the neck) *

Behavior

How long have you had your dog? *

Where did you get your dog? *

If your dog was adopted or rescued, do you have any back story on them? *

What other types of pets do you have? *

How does your dog interact with other pets and/or humans including children, in the home or out in public? *

How does your dog react with visitors in the home? *

Are there any type/breed of dogs that your dog fears? *

Is there any type of person that your dog fears? (gender, behavior, clothing, items etc. *

Has your dog ever aggresively growled, snapped or bitten a person or another dog? *

Does your dog growl or become aggressive around food or when playing with toys? *

Does your dog share well with others? (food, toys, beds, etc.) *

Has your dog ever been in Doggie Day Camp? *

Does your dog go to an off leash dog park? *

Yes
No

Can your dog climb or jump a fence? If so, please say how high. *

Does any of the following apply to your dog? *

(Check all that apply. If none, check "None")

Elaborate in detail if you checked any of the options above: *

Is there anything else about your dog that we need to know? *

May we give your dog doggie treats? *

Yes! Please.
No, Thank you.

(Pick One)

Where is your dog's favorite spot/place to be petted?

Does your dog know any trick(s)?

By typing my name below and submitting this form, I certify that I am the legal owner/responsible party and over the age of18 years old, for the dog mentioned above in this form. And the information provided is all true and accurate to the best of my knowledge. In the event that an issue arises later, and information is found that was withheld from this form or was false, will be cause for the immediate removal from our DDC program.

Today's Date: *

Electronic Signature: *

Clear Signature

Please do not submit any Protected Health Information (PHI).

Online Form

Doggie Day Camp Application Form