Please read this form and the accompanying Terms and Conditions carefully.

This level of detail is required to ensure we can provide the highest level of care and

safety for your dog.

 

Please  complete and sign this form (including  acceptance  of  the Terms  and  Conditions,

Off  the  Lead  Consent  Form  and  Waiver of Liability).

 

General Information

 

Your Name ……………………………………………………………………………………………………..

 

Address  ………………………………..……………………………………………………………………..

 

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Email Address ……………………………………………………………………………………………………..

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Contact Numbers :-

 

Home   …………………………..….. Mobile…………...…………..….. Work …………………………………

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Alternative Contact

 

Name ……………………………………………………………………………………………………..

 

Address  ……………………………………………………………………………………………………..

 

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Email Address ……………………………………………………………………………………………………..

 

Contact Numbers :-

 

Home   …………………………..….. Mobile…………...…………..….. Work …………………………………

 

 

 

Emergency Contact

 

Name ……………………………………………………………………………………………………………...

 

Home   …………………………..….. Mobile…………...…………..….. Work …………………………………..

 

 

Vet

 

Name    ……………………………………………     Address     ………………………………………………...

 

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Phone    ……………………………………     Email     ….………………………………………………………..

 

 

Security Information

 

 

Gate Codes …………………………………………………………………………………………………

 

 

Alarm Instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Dog's Details

Name     ……………………………………..………. Age     ………………………… Gender M/F    ………..……….

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Breed     ……………………………………………………………...….    Colour    ……………………………………

 

Is Your Dog Microchipped ? (Y/N)    ………….………   Chip No    ………………………..…………………….

 

Is Your Dog Insured ? (Y/N)    ……………..    How Long Have You Owned Your Dog  ?  ……………………..

 

Please Briefly Describe Your Dogs History ( If Adopted Etc.)

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Neutered ?     Yes /  No, but will be by     …………………………………………..….

 

 

Un-Neutered Bitch ?     Yes /  No                   Date Of Last Season    …………………………….........................

 

                                                

Up To Date With Vaccinations                   Yes /  No but will be by    …………………………….….…………..….

 

 

 

 

Allergies ?

 

 

 

 

 

 

 

 

 

 

 

 

 

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Please List Any Pre-Existing Or Current Health Conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

            Please List Any Medication Your Dog Is Currently Taking And Instructions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

             Please List If Your Dog Has Any Sensitive Areas On His/Her Body

 

 

 

 

 

 

 

 

 

 

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Please Describe Any Restrictions On Your Dog’s Activity (Due To Physical Limitations Such As Hip Dysplasia ) ?

 

 

 

 

 

 

 

 

 

 

 

 

 

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Is your dog allowed treats while under the care of Dog Walking Oxted ?          Yes / No

 

                                                                                                                       

Social Skills

 

 

Please Give A Brief Description Of Any Formal Obedience Training Your Dog Has Received

 

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How Does Your Dog React To Other People And Dogs When On Walks ?

 

 

 

 

 

 

 

 

 

 

 

 

 

Behaviour

 

Please Describe General Behaviour And Energy Levels (Both Inside And When Out)

 

 

 

 

 

 

 

 

 

 

 

 

 

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Please Provide Some Details If Your Dog Is Anxious Around Or Frightened By Any Of The Following

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Noises    …………………………………………………………………………………………………………..

 

 

Actions   ………………………………………………………………………………………………………….

 

 

Objects   …………………………………………………………………………………………………………

 

 

Other Breeds Or Types Of Dogs    …………………………………………………………………

 

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People     …………………………………………………………………………………….………………...

 

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Does Your Dog Ever Get Car Sick ?                   Yes  /  No

 

 

Does Your Dog Have A Specific Command To ‘Go To The Bathroom’ ?         Yes  /    No

 

 

Does Your Dog Behave Differently On And Off Lead ?      Yes  /  No

 

 

 

If Yes, How ?

 

 

 

 

 

 

 

 

 

 

 

 

Does Your Dog Play Well ‘Off Lead’ With Other Dogs ?            Yes  /  No

 

 

Does Your Dog Live With Children ?       Yes  /  No

 

 

 

If Yes, How Many And What Age Group ?

 

 

 

 

 

 

 

 

 

 

 

How Does Your Dog Behave Around New Children ?

 

 

            Well                  Badly                OK                    Generally Avoid

 

 

How Does Your Dog Behave Around Livestock ?

 

 

            Well                  Badly                OK                    Generally Avoid

 

 

Has Your Dog Ever Jumped On Someone ?           Yes  /  No

 

 

If Yes, Please Describe The Circumstances

 

 

 

 

 

 

 

 

 

 

 

 

Has Your Dog Ever Growled At Somone ?          Yes  /  No

 

 

If Yes, Please Describe The Circumstances

 

 

 

 

 

 

 

 

 

 

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Has Your Dog Ever bitten another dog other than play - biting ?          Yes  /  No

 

 

 

If Yes, Please Describe The Circumstances

 

 

 

 

 

 

 

 

 

 

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Does Your Dog Allow You To Take Things Out Of His/Her Mouth  ?            Yes  /  No

 

 

What type of dogs does your dog prefer to socialise with ? (small, females, playful, calm etc.

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     ​Will Chase -         Cats  - Deer  -        Livetsock  -          Small Animals    

 

Recall  -               Yes  Always  -    Usually      -        Occasionally   -       Never

 

        Off Lead With Owner   -     Very Good  -    Average     -     Poor

 

 

 

Type Of Lead      -      Standard   -   Extendable               

 

Type of Restraint -  Muzzle   -  Standard Collar   -   Halter Harness  -  

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                            Other ………………………………  

 

 

 

Please Describe Pick Up And Return Routine

 

 

 

 

 

 

 

 

 

 

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Please give any other information that you think would be useful to enable us to give your dog the best possible

care while under the care of Chic Dog Walking

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Disclaimer And Waiver Of Liability

 

The information I have given is true, correct and complete to the best of my knowledge.

 

I have read and agree to abide by the Terms and Conditions for services received from Chic Dog Walking. 

I hereby indemnify Chic Dog Walking services and their staff against liability of any kind whatsoever

arising from my dog’s participation in any services offered by

Chic Dog Walking.

 

 

Full Name     …………………………………………………………………………………………………………….

 

Date     …………………………………………………….

 

 

           

 

Off The Lead Consent Form

 

I agree to Chic Dog Walking having the right to allow my dog off the lead and understand

that all terms and conditions remain the same.

 

I have read and agree to abide by the Terms and Conditions for services received from Chic Dog Walking services. 

I hereby indemnify Chic Dog Walking services and their staff against liability of any kind whatsoever

arising from my dog’s participation in any services offered by

Chic Dog Walking services

 

 

Full Name     …………………………………………………………………………………………………………….

 

Date     …………………………………………………….

 

 

            

 

 

Key Holder Disclaimer And Waiver Of Liability

 

I have read and agree to abide by the Terms and Conditions for services received from Chic Dog Walking. 

I understand that this form acts as permission to hold keys to my property which I have provided willingly. 

I hereby indemnify Chic Dog Walking and their staff against liability of any kind

whatsoever arising from damage or loss of any property.

 

 

Full Name     …………………………………………………………………………………………………………….

 

Date     …………………………………………………….

 

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