Questionnaire

9600 SW Luelling Pl; Beaverton, OR 97008

email: comesitstayboarding@gmail.com

Phone: 503-780-7135

Owner(s) Information		Veterinarian Information
Name		Clinic Name
Address		Doctor Name
City, State, Zip		City, State
Email		Phone
Phone
Cell Phone
Emergency Contact (In case you cannot be reached; someone who can pick up pet(s)
Name / Relationship
Email / Phone
Pet Information
Pet (1): Name		Pet (2): Name
Breed:		Breed:
Description:		Description:
Sex:	Male Female	Sex:	Male Female
Spay / Neuter:	Yes No	Spay / Neuter:	Yes No
Age		Age
Medications? Dosage/Frequency		Medications? Dosage/Frequency
Any current symptoms? (Diarrhea, Allergies, etc)		Any current symptoms? (Diarrhea, Allergies, etc)
VACCINE HISTORY
REQUIRED: Please provide a copy of vaccination record from your vet. All dogs must be up to date on vaccinations.
• Rabies	• DHLPP (Distemper, Hepatitis, Leptospirosis, Parainfluenza, Parvovirus)	• Bordetella (Canine infectious tracheobronchitis (aka kennel cough)
FOOD & TREATS
While boarding your dog, it is important to keep him/her on the same food/treats they are fed regularly. Please bring enough food/treats to last the entire stay. Packing an extra day is a good idea.
Pet 1: Does your dog exhibit food aggression?	Yes No	Pet 2: Does your dog exhibit food aggression?	Yes No
Feeding Schedule / Amount:	Sample: 2x day – 1 cup each	Feeding Schedule / Amount:	Sample: 2x day – 1 cup each
Treats?	Yes No	Treats?	Yes No
EXERCISE / SLEEPING
With the owner’s permission, guests are given daily walks in the morning and evening.	Yes No	I have an ‘open couch’ and ‘open lap’ policy for my guests. If the owner doesn’t specify sleeping habits, guests are in my room and/or on bed. I have crates available (small to large) if owner favors crates for sleeping.
		Is your pet crate trained?	Yes No
BEHAVIOR / PERSONALITY (Please describe i.e., Happy, Playful, Shy, Nervous, Cuddly, Separation anxiety, Barks, etc)
Personality Example: Social butterfly, Curious, Cuddly, Shy, Nervous, Escape artist, Separation anxiety, Chews, Digs, Barks, Other…?
Describe personality:
Toy / Object Possessive		Yes No
People Aggression		Yes No
Food Possessive		Yes No
Is your pet afraid of any specific items or noises? (i.e., July 4th fireworks, thunderstorms, etc.)			Yes No
Has your pet ever growled, lunged at, or bitten anyone? Please describe:			Yes No
Has your pet been socializing with other dogs? People?			Yes No
Has your pet ever had any formal obedience training?			Yes No
What verbal commands do you use for your pet? (i.e., come, sit, stay, etc.)
Other comments about your dog, which might be helpful:
Payment / Rates Payment in full for all charges incurred on behalf of boarding are due upon pick-up. Acceptable Method: Cash preferred, Check or Zelle (503.780.7135)
Per Hour: $5 (After 5hrs up to 20hrs; standard night fee applies)	Per Pet/Per Night: Dog =$ 20 Per Pet/Per Week: – Dog =$120 7th night free		Discount: 10% • Multi Paw family (same booking); max 3 pets • Returning guests

Agreement and Release

1. Vaccinations are current.

2. I verify that my dog is healthy, has the required vaccinations on file, is free of sickness or disease and has not harmed or shown aggression towards people or other dogs.

3. In the event I cannot be reached by phone, I agree to allow Tami Miller of Come Sit Stay LLC to transport my dog to my veterinarian (listed above) or Dove Lewis Animal Hospital or the nearest available veterinary clinic for treatment of any sickness or symptoms that occur during boarding. I also agree to pay for all expenses for any veterinary services or on-site services that result from that occurrence.

4. Pictures of pets will be exhibited on Come Sit Stay LLC site(s) and may be used for marketing.

5. I certify that I have read, understand, and accept this agreement and Release.

Owner's Name

Owner’s Signature:

Date:

I do not wish to have my pet’s photos shared on webpage.