(815) 288-3394

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Home
About
Services
Resources
Contact
Request Appointment
Order Online

Dog Daycare Enrollment Form

Save time dropping your pup off at our daycare by completing our online enrollment form.

Online Form

Please fill out this form as completely and accurately as possible so we can get to know you and your pet(s) before your visit.

Dog Daycare Enrollment Form

Dog's Name *

Dog's Date of Birth

Owner's Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Home Phone

Work Phone

E-mail *

Breed

Sex

Male
Male/Neuter
Female
Female/Spay

Veterinary Clinic:

Primary Veterinarian:

Emergency Contact (Other Than Yourself And Spouse): Please List Relationship And Contact Phone Number.

Who Referred You?

List Any Known Allergies:

How Often Do You Think You Would Like To Use The Day Care Service? (Minimum One Day Per Week).

Has your dog been enrolled in day care before?

Yes
No

If yes, where?

Vaccination/medical History

Vaccines and parasite testing performed at River Ridge Animal Hospital

Yes
No

Rabies due:

Lepto due:

DHPP due:

Bordetella Due (Required every 6 mo.):

Yearly heartworm testing last done on:

What heartworm preventative brand are you using?

Heartgard Plus
Advantage Multi
Nexgard Plus
Interceptor Plus

If you checked other please list brand:

Flea and tick preventative last given on:

What brand of preventative are you giving?

Vectra 3D/Vectra
Advantage Multi
Nexgard
Nexgard Plus

If you checked other, please list brand:

Fecal flotation last done on:

Please describe any medical/health issues we need to be aware of (i.e. seizures, heart, hip problems, etc.):

Anything contagious? Please list and dates diagnosed:

Microchip number:

Dog Profile:

How long has your dog been in your family?

Where did you get your dog?

If adopted, do you have any knowlege of your dog's past history? Please explain.

How many people are in your family? Please list adults and children, male and female and ages.

Has your dog had obedience training?

Yes
No

If yes, to what level and/or activity?

Do you use a crate?

Yes
No

Is your dog comfortable in a crate?

Yes
No

Is your dog comfortable having his/her feet touched?

Yes
No
Don't know

Is your dog comfortable having his/her collar used to lead?

Yes
No
Don't know

Has your dog ever climbed or jumped a fence?

Yes
No
Don't know

Has your dog ever growled or snapped at anyone who's touched his/her bones, food or toys?

Yes
No
Don't know

Does your dog play with other dogs on a regular basis?

Yes
No

If yes, would you say he/she plays nicely?

Yes
No

Comments on playing with other dogs:

Does your dog prefer certain sexes of dogs?

Yes
No

If yes, which sex?

Does your dog automatically dislike any kind of dog?

Yes
No

If yes, what kinds of dogs?

How does your dog react to puppies?

Happy to see them
Indifferent to them
I don't like you
Go away

How does your dog react to strangers?

Happy to see them
Indifferent to them
I don't like you
Go away

Does your dog automatically dislike any kind of person?

Yes
No

If yes, what types of people?

Describe any behavioral problems/idosyncracies/special sensitivities we should be aware of:

Please Notify Us Immediately If Any Of The Above Information Changes!

For Office Use Only

Vaccine information verified. Please enter date and initials.

Temperament testing date:

Temperament test results:

Comments/Concerns:

Signature *

Clear Signature

Email

Ready to Visit?

We proudly serve the pets of Dixon, Sterling, Rock Falls, Morrison, Amboy, Ashton, Oregon, Rochelle, IL, and the surrounding area. Feel free to visit our clinic or request an appointment by clicking the button below.

Call Now

Have a Question?

Please complete our online form and a member of our team will get back to you as quickly as possible.

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Location

273 IL Route 2
Dixon, IL 61021

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Contact Information

Phone: (815) 288-3394
Fax: 815-288-3549
Email: staff@riverridgevets.com
Kennel Department
Email: kennel@riverridgevets.com

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Hours

Monday–Friday: 7:30 AM – 5:30 PM
Saturday: 7:30 AM – 12:30 PM
Sunday: Closed

Name *

First

Last

Email *

Phone

How can we help you? *

Name

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