Concept · printable master — use the Google Form for live intake

Client Intake Form

La Palma Dog Club — a working name. Boutique home dog boarding, La Palma, CA.

Please fill this out completely and bring it (or the vaccination records it references) to the meet & greet or drop-off. Fields marked * are required — several are liability-protective disclosures, so honest, complete answers protect your dog and every other guest here.

Owner & contacts

Owner full name *

Best phone (call/text) *

Email *

Home address *

Emergency contact — name + phone * (someone other than you)

Authorized alternate pickup — name + phone (optional)

The dog

Dog's name *

Breed / mix *

Weight *

Age *

Sex *

Spayed / neutered? *

Color & markings (for ID)

Microchip number

Photo attached? * clear, recent photo stapled or clipped to this form

Yes, attached

Vet & health

Primary vet — clinic name, phone *

Vaccinations current? * — Rabies / DHPP / Bordetella (attach proof)

Rabies current
DHPP current
Bordetella current
Proof attached

Flea & tick prevention — product + last dose

Recent illness or injury (last 30 days)?

Medical conditions / diagnoses

Allergies — food & environmental

Current medications — name, dose, time(s) given (add a row per med)

Medication	Dose	Time(s) given

Feeding

Food brand & type *

Amount per meal *

Meals/day + times *

Owner providing food? * (strongly preferred — avoids GI upset)

Treats allowed? Which / how often

Feeding notes — slow feeder, feed separately, elevated bowl, etc.

Routine & behavior

Potty schedule & how the dog signals *

Crate-trained? *

Where does the dog sleep at home?

Exercise needs — walks/day, energy level

Commands the dog knows

Leash behavior — pulls / reactive / calm

Reactivity (disclosure) * — toward other dogs / people / noises? Describe:

Resource guarding (disclosure) * — food, toys, space? Describe:

Separation anxiety?

Escape risk (disclosure) * — fence jumper / door bolter?

Bite history (disclosure) * — any history of biting or aggression? (Required — honest answer protects everyone.)

Social

Good with other dogs? * (this is a shared-home environment)

Good with cats / kids?

Play style — gentle / rough / vocal

Anything that stresses this dog

Belongings checklist — what comes with the dog

Food (measured for the stay)
Bowls
Leash / collar / harness (ID tag on)
Bed / blanket
Toys
Medications
Comfort item

Authorizations & agreement

Emergency vet authorization * — In an emergency where you can't be reached, I authorize transport to a vet and treatment up to $ before further contact. (Suggested default: $750.)

Photo / social-media consent — may I share photos of your dog in report cards and marketing? *

Yes
Report cards only
No

Pool access — may your dog be in the pool area, under my full, direct supervision at all times? (blank or unanswered = no pool access)

Grooming — may I bathe/rinse the dog if needed?

I've read and agree to the boarding policies (cancellation, pickup window, vaccination requirement). *

Agreed

Signature *

Date *