Today’s Date*:
How did you hear about us?:
Atlanta Humane Society
Atlanta Magazine
Atlantic Station
Banners at Street
Billboard
Building Sign
Customer Referral
Doguroo Park (Atlantic Station)
Doguroo Website
Facebook
Food Company Website
Internet Search for Dog Services
Internet Search for Pet Retail
Kudzu
Local Event
Trainer
Veterinarian
Word of Mouth
Yelp
OTHER
Name of person/business that referred you:
(Please provide us with a name so they can receive their Referral Bonus!)
Owner’s Information
Name*:
Address*:
City*:
State*:
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip*:
Email*:
Home Phone*:
Cell Phone:
Work Phone:
2nd Owner Name:
2nd Owner Phone:
Emergency Contact Name*:
Emergency Contact Phone*:
Please list any additional people authorized to pick-up or drop-off your dog:
Please tell us which Doguroo Services you plan to use*:
Puppy Hour
Daycare Only
Boarding Only
Grooming Only
Training Only
Mainly Daycare
Mainly Boarding
Mainly Grooming
Mainly Training
All Services
Has/have your dog(s) ever participated in daycare/group play? (Y/N)*:
Yes
No
If Yes, briefly tell us about the experience including why you may be making a change (please do not include other business names):
Dog Information (Dog’s must be from the same family/household)
1st Dog
Dog’s Name*:
Color(s)*:
Sex*:
Male
Female
Spayed/Neutered? (Y/N)*:
Yes
No
Breed (if mix, best guess)*:
Weight*:
DOB (or best guess)*:
Brand and type of food currently fed:
2nd Dog
Dog’s Name:
Color(s):
Sex:
Male
Female
Spayed/Neutered? (Y/N):
Yes
No
Breed (if mix, best guess):
Weight:
DOB (or best guess):
Brand and type of food currently fed:
3rd Dog
Dog’s Name:
Color(s):
Sex:
Male
Female
Spayed/Neutered? (Y/N):
Yes
No
Breed (if mix, best guess):
Weight:
DOB (or best guess):
Brand and type of food currently fed:
Veterinarian Information
Hospital/Clinic Name*:
Veterinarian Name:
Address:
Phone*:
Last visit (approximate date):
Flea Control (ex. Frontline):
Heartworm Preventative (ex. Heartguard):
Allergies:
Describe any health problems:
Proof of the following current vaccinations must be provided in writing before any dog is admitted into our facility:
Rabies
DHLP or DHLPP
Parvo
Bordatella (Kennel Cough)
By filling in the signature box (to the right) with your name and pressing the “Register” button at the bottom of this page, you agree to the terms & conditions below: