Application for Daycare - Darwin Airport

Do you authorise anyone else (besides the people named above) to collect your dog on your behalf? *
 No   Yes

If yes, name of authorised person(s):
Please note: we are unable to discharge dogs to anyone not identified as the owner above, without prior authorisation by you.

I would like to hear of events happening at The Furry Godmother by email *
Yes    No

How did you hear about us?

Please Select One Radio Google Ad/Internet Search Facebook Referral by a friend Vet Practice Referral Brochure/Flyer Yellow Pages/Local Directory Bus/Vehicle Advertising Expo Other

Registered with council? *:

Please Select One Darwin City Council Palmerston City Council Litchfield City Council Other (Complete details below) None

Other (please write council name):

Has your dog every holidayed at The Furry Godmother Pet Resort? *   Yes    No

What is your preferred date for the first assessment day? (Please note: we will contact you to confirm this date.) *:

Do you want to continue regular bookings after the assessment day, or will this be a casual booking? *
Yes, I would like regular bookings    No, this is a casual booking

If yes, what days/schedule would you like to book?

Do you require the Pet Taxi to collect your furkid from home, or deliver home?
No     Pick Up Only     Drop Off Only     Pick Up and Drop Off

Vet Clinic *:

Please Select One All Pets Veterinary Hospital (Rapid Creek) Darwin My Vet Service (Wulagi) Darwin Veterinary Hospital (Casuarina) Girraween Veterinary Hospital Howard Springs Veterinary Hospital Humpty Doo Veterinary Hospital Julie Baronio Litchfield Veterinary Hospital Nightcliff Veterinary Clinic Palmerston Veterinary Hospital Parap Veterinary Hospital Rebekkah Chiam The Ark Veterinary Hospital (Yarrawonga) University Ave Veterinary Hospital (Durack) Vet 2 Pet Mobile Veterinary Services Alice Veterinary Centre Barkly Veterinary Practice (Tennant Creek) Desert Oak Veterinary Clinic Katherine Vet Care Centre (Fourth St) Katherine Veterinary Clinic/NT Vet Services (Second St) The Alice Springs Veterinary Hospital Other (Complete details below)

Other (please write clinic name and phone number):

While the safety, health and well-being of your pet is paramount to us, we understand that there are times when unforeseen things happen. In this event we do have a veterinarian on call. We are happy to use your nominated vet if you prefer – providing they are available. All veterinary and associated costs will be your responsibility.

PLEASE NOTE: Proof of vaccination (minimum of C5) and desexing is required prior to your dog’s first day. Instructions on how to supply this will be sent in your acceptance letter.

Please tick this box to acknowledge that you understand this.

MEDICATION

Heartworm Prevention Brand *:

Date Due *:

Intestinal Worm Control Brand *:

Date Given: *

Flea/Tick Prevention Brand *:

Date Given *:

Other Medications:

Medication 1 - Name:

Medication 1 - Dose:

Medication 1 - Frequency Given:

Medication 1 - Reason/Condition:

Medication 2 - Name:

Medication 2 - Dose:

Medication 2 - Frequency Given:

Medication 2 - Reason/Condition:

Medication 3 - Name:

Medication 3 - Dose:

Medication 3 - Frequency Given:

Medication 3 - Reason/Condition:

Does your dog have any hip/joint problems? *:   Yes      No
If Yes, has he/she ever been x-rayed for this condition?   Yes      No

Does your dog have any skin problems? *:   Yes      No

Has your dog had any ear problems? *:   Yes      No
If yes, when? Is he/she currently under treatment?   Yes      No

Are there any play activities your dog cannot participate in? *:   Yes      No
If Yes, please give details:

Does your dog have any sensitive areas on his/her body that he does not like touched? *:   Yes      No
If Yes, please give details:

Has your dog been sick within the last 2 months? *:   Yes      No
If yes, when and what was the treatment?:

Does your dog have any allergies or food restrictions? *:   Yes      No
If yes, please list these:

HISTORY

Where did you acquire your dog?: *

How old was he/she?: *

BEHAVIOUR

How does your dog react to new people/dogs coming into your house? Does he/she *
Growl       Bark      Hide      Wag Tail      Jump Up

Are there any kinds of people/dogs that your dog fears or dislikes? For example: a particular breed/type of dog, human men, children, tall/short people, elderly people, postmen?

Has your dog ever bitten a person or another dog? *  Yes      No
If so, what were the circumstances:

Has your dog ever snapped at a person or another dog? *  Yes      No
If so, what were the cirumstances:

Is your dog overly frightened or nervous about anything? For example: vacuum cleaners, thunder, fireworks, hats, umbrellas?

How does your dog react to other dogs approaching when he/she is:
On lead:    Growl       Bark      Hide      Wag Tail      Jump Up
Off lead:    Growl       Bark      Hide      Wag Tail      Jump Up

Has your dog ever Jumped or climbed over a fence?: *
Yes      No
If so, how high was it?

Does your dog have any of the following habits?:
Urinating inside the home
Excessive barking
Chewing /Destructiveness
Separation Anxiety (crying when left alone)
Mouthing your hands or clothing

How often and where does your dog socialise with other dogs?: *

Are you able to remove items (including food) from your dog? *  Yes      No

Is your dog travel crate trained? *  Yes      No

What do you do with your dog when you are not at home? : *

What type of collar do you walk your dog in?*

Does he/she
Pull on the lead      Walk next to you     Walk behind you

What obedience training has your dog had? : *

What commands do they understand? : *

What other comments or information about your dog that you feel might be helpful? :

Thank you for assisting The Furry Godmother by providing the above details. This will assist us to tailor our care to suit your dog. We promise that we will care and nurture your beloved dog as you would at home.