Windmill Lane Boarding Kennel
Phone: (641) 623-7233 eMail: Registration@WindmillLaneBoardingKennel.com
Client and Guest Registration Form
Client Information:
Name: Primary Phone:
Mobile (or Home) Phone:________________ Work Phone:________________
Email:
Address: ___________________________________________________ ____
Emergency contact if we cannot reach you:
Name Phone:
✘ Authorized to Pick-up
☐
Additional Pick Up and Drop Off Permission: _________________________________
Veterinarian Information: Farm & Family: ☐Monte ☐Brooklyn
✔ ☐Victor
☐Grinnell Vet Clinic ☐Grinnell All Pets ☐Lynnville-Sully Vet Clinic
☐Mahaska Vet Clinic ☐Oskaloosa Small Animal Clinic ☐Williamsburg Vet Medical Center
Other: ✔
Name/Clinic/Hospital:
Address:_____________________________________________________________________________
Phone:________________________________ Fax:_____________________________________
How did you hear about Windmill Lane Boarding Kennel?
_______________________________________________
Would you like to receive email/mail updates and coupons from us? ☐ Yes ☐ No
May we use pictures & content of you and your pets for marketing purposes, such as our
website, or newsletter? ☐■ Yes ☐ No
Guest Information: (please complete for each guest)
Client’s Primary Phone: Client Name:
Guest Name:___________________________________ Breed:__________________________
■ Male or ☐ Female (check one)
☐ ☐ Spayed/Neutered (check if applicable)
Birthdate: __________________ Color:_______________ Weight:________________________
Personality Profile:
How long have you had your dog? _____________________________________________________________
How did you get your dog? __________________________________________________________________
Check all that apply to your dog: ☐Outgoing
■ ☐Timid ☐Pushy ☐Affectionate
■ ☐Submissive ☐
Insecure ☐Excitable ☐Playful
■ ☐Gentle ☐Quiet ☐Territorial ☐Dominating ☐Loud
What is your dog’s activity level? ☐ Low ☐
■ Medium ☐High
List all situations in which your dog may become unfriendly or aggressive (e.g. disturb during feeding):
If your dog becomes unfriendly they (check all that apply):
☐Will Bite ☐May Bite ☐Growl ☐Show Teeth ☐Tremble ☐Raise Hair On Back ☐Move
■ Away.
Is your dog sensitive to noise? ☐No
■ ☐Yes (describe)__________________________________________________________
Does your dog like other people? ☐Yes
■ ☐No (describe)_______________________________________________________
How is your dog kept when you are not home ☐
■ crated, ☐ fenced, ☐
■ free to roam ☐ doggy door
How does your dog react when approached by other dogs? ____________________________________________
Has your dog ever tried to jump a fence? ☐ Yes ___________________________________________________________
Does your dog have any health issues? ____________________________________________________________
Is your dog allergic to anything? __________________________________________________________________
What is your dog’s feeding schedule? __.__ cups____________________________________________________________
Does your dog respond to any commands? ☐Sit ■ ☐Stay ☐Wait ☐Kennel ■ (up) ☐uses a doggy door
☐ None ☐ Other
Other information about your dog’s temperament or any social issues we should be aware of:
_____________
_____________
