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Client Profile

First Name:
Last Name:
Street Address:
City:
Province:
Postal Code:
Major Cross-Streets:
Day Phone:
Evening Phone:
Cell Phone:
Email Address:
Date and time you will be leaving:
Date and time you will be returning:

Dog Profile

Is your dog spayed or neutered?Yes No
Is your dog house-trained?Yes No
Is your dog aggressive toward adults?Yes No
Is your dog aggressive toward children?Yes No
Is your dog aggressive toward dogs? Please explainYes No
Has your dog ever bitten anyone?Yes No
Does your dog have any health issues? Please explain:Yes No
Does your dog have any behavioural problems? Please explain:Yes No
Does your dog use any medication? Please explain:Yes No
Is there anything else about your pet we might need to know?
Do you have any special instructions for your host family?
Does your dog live with children? Min age and max age:
Is your dog aggressive toward cats? Please explain:Yes No
Where does your pet sleep?

Emergency Contacts

Emergency Contact One:

Name:
Phone Number

Emergency Contact Two:

Name: 
Phone Number: 

Veterinary Information

Veterinary Name:
Veterinary Number:
Veterinary Street Address:
Province:
Postal Code:
Major Cross-Streets: