Summer Camp Application

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"*" indicates required fields

Owner Information

Owner’s Name:*

First Last

Address:*

Street Address Address Line 2 City State ZIP Code

Phone

Home:

Work:

Cell:

Please provide at least one number.

Email Address:*

Camper Information

Camper's Name:*

Date of Birth:

Weight:*

Breed:*

Sex:*

Male

Female

Is your camper Neutered or Spayed?*

Yes

Are you a client of Montrose Animal Hospital?*

Yes

If not a client of Montrose Animal Hospital, please tell us what veterinary hospital does your camper go to?

Phone Number of Veterinary Hospital:

Emergency Contact Information

Name:

Emergency Contact Phone:

Home Number:

Work Number:

Cell Number:

Please provide at least one number

Persons authorized to drop off and pick up my camper:

to add more names, click the plus icon

Summer Camp Interview Questions

Does your dog have any allergies or medical conditions we should be aware of?*

Yes

If "Yes" above please explain.*

Has your dog ever played with other dogs in a group environment before?*

Yes

Does your dog prefer to play with small, medium or large dogs?*

Has your dog ever shown signs of aggression to other dogs or humans, including growling?*

Does your dog have any history of being attacked or abused?*

Does your dog show any resource guarding behaviors (growling at others when they have a toy, or getting pets from a human? Crouching over a toy and hard staring at other dogs as they get close? Snapping or lunging at other dogs if they come close while your dog has a toy, or is with a human getting affection?)*

Have you ever visited Montrose Animal Hospital before?*

Yes

What is the primary reason for using the Summer Camp Program?*

If "Other" above, please explain.*

Is your dog current on vaccinations?*

Yes

Is your dog current on the Canine Influenza/CIV vaccination?*

Yes

Is your dog up to date on Flea/Tick/HW prevention?*

Yes

How many times a day does your dog eat?*

Is your dog on any medications we should be aware of?*

Yes

If "Yest" above, please explain medications.*

Describe how your dog likes to play with other dogs, also describe what your dog (doesn’t) like other dogs to do.*

Does your dog require any special attention while outside in warm temperatures? Are they prone to overheating or breathing issues?*

Does your dog have a habit of eating toys, plastics, or any other nonfood objects?*

Does your dog get mouthy, play bite or nip at people’s arms/legs or at other dogs legs while running/playing?*

Does your dog suffer from separation anxiety, or stress when in a place without you or when in a new environment?*

Camp Policies, Procedures and Camper Release, Waiver or Liability, Assumption of Risk and Indemnification Agreement

Owner's Signature:*

Owner's Printed Name*

First Last

Date Completed:*

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Phone

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Summer Camp Application

Owner Information

Camper Information

Emergency Contact Information

Summer Camp Interview Questions

Camp Policies, Procedures and Camper Release, Waiver or Liability, Assumption of Risk and Indemnification Agreement

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