Long Beach WA
360.642.2944
REGISTRATION & INTAKE FORM 

PENINSULA PET SITTING, LLC 
360.642.2944
Registration & Intake Form 
If you feel we may be the right care-givers for your dog when you can't be, 
your next step is to give us a call ~ then get registered with us.  

 There is no obligation, of course!

.  We simply want to get to know your dog and be prepared for their visit.  
Likewise, give us a call & get to know us, too!

How did you hear about us?
Today's Date

 EZ TIP Use your TAB button to navigate through this form 
* ABOUT YOUR DOG * ABOUT YOUR DOG * ABOUT YOUR DOG *
Your Dog's Name & Nickname/s
Is your dog
on medication?
FEEDING INSTRUCTIONS:  

Dogs who overnight & vacation with us eat their own food that you bring along
Tell us the following below:  Are they a "grazer?" Dine once a day; twice a day?  What about treats:  Frequent?  Limited?  For praise only?  Or do you "go with the flow" regarding daily treats?  
Especially important:  if your dog is "watching their weight" and currently dieting, let us know.

Please provide this information, including their customary brand of food, here:
A NARRATIVE ABOUT YOUR DOG:  
Please answer the following in the text box below 

FIRST:  On a scale of 1 to 10, indicate how well socialized your dog is. 
"1" = tells us they are not used to being with other dogs; a "10" tells us that they love everybody, people and dogs alike!  

Now describe their general TEMPERAMENT.  Are they pretty well socialized; easy-going, easily meet other & play with other dogs?  Do they fetch tennis balls, Frisbees, play with rope toys and considered the life of any dog-party?  Perhaps your baby is the opposite ... preferring people over other paws and is more on the shy & reserved side.  If your baby is a senior citizen dog now and probably won't play much, this is the place to describe their daily habits and needs .    

Please be generous with your description.  A long narrative is great.  The more we know, the better!

Training:  Tell us about your dog's training.  Have had formal classes -or- basic informal training by you?  Be sure to describe which basic commands they are familiar with.

Any past incidents?  If your dog has ever been in a tussle with another dog, describe the incident and how long ago.  

Sleeping Arrangements:  Where does your dog sleep at home?  On their special doggie bed or blanket; a sleeping crate; on the couch, in your room, perhaps right on your bed?  If possible, we want to duplicate that here for their Vacation stay!    

Health Matters:  What are your dog's health issues, if any?  (Remember:  IF on medication, describe condition, name of medication & dosing information in the special "Medication Info" text box above.)  
* SPECIAL NOTE FOR TWO-DOG FAMILES * 

Submit this form, fire up another with your name, email & phone only 
in the top portion, then fill out and submit a second form for your second dog. 
VETERINARY INFORMATION 
Just as if we were providing care for your child, having your authorization to seek medical attention 
in case of an emergency with your dog is important!  Thanks.  
Provide your  Vet's Name, Clinic Name, City and Phone in the textbox below.  
In the event of an emergency, my electronic signature below authorizes you, a licensed Veterinarian, 
to treat my pet for any emergency medical treatment you deem necessary in my absence.  
If necessary, my dog's vaccination paperwork will be provided to you by my pet sitter. 
I certify that my dog is current on his or her annual vaccinations and has been immunized for bordetella.      

This is a one-time registration and, along with a copy of your dog's most current vaccination records and proof of bordetella, must be submitted prior to your dog's first stay.  



--- Veterinary Treatment Authorization ---
Electronic Signature Required
EMERGENCY CONTACT PERSON ~ Required Info:  
Please provide the name, town, and phone number for a local friend or family member:  
Your Name/s
Mailing Address, City - State - Zip
Your Primary Email
Secondary Email, optional
Home Phone

Spouse's Cell, if applicable.  Please identify whose number this is. 
How many dogs in your family?
In the text box below, describe in-general your Doggie Care needs.  For Example: 
LOCAL (Padific & Clatsop County) DOGS:  An upcoming vacation?  Occasional weekends away?  Occasional or possible future/regular Doggie DayCare?
PENINSULA VISITORS and their RESORT DOGS:  If your dog is coming along on your beach vacation and needs care, 
simply indicate whether you need *overnights" -- for your non pet-friendly hotel accommodations, or *Doggie DayCare"  
Section I:  * ABOUT YOU *  OUR DOGGIE PARENT * 
Breed
Color/s
Approx 
Weight
Current Age
Altered?
Any formal 
training classes?
Microchipped? 
and birthday 
if you know it
360 642-2944   

Phone Hours:  
Although here 24/7 with the dogs. best times to call are:
 
10:00a thru 6:00p weekdays 

10:00a thru 5:00p on Saturdays;
12-noon thru 5:00p on Sundays.

We are often outdoors with the dogs or their parents and may miss your call.  There is no voice mail on this line so if that happens?  No worries!  Just give it a bit and call back again soon.
If you ran out of room --OR-- have any questions for us, this is your text box:  
Note to Two (or more) Dog Families:
Information on submitting this form for additional dogs can be found below.  
Each of your Furry Little Loves requires 
their own form.

Important:  This form is being submitted for:
SUBMIT BUTTON

  THANK YOU

for your interest in our little Doggie Hotel and Playground in Long Beach!

We look forward to hearing from you.

 * WOOF *
My dog is a
Punch 
the 
Paw
Punch 
the 
Paw

* CAREFUL! * 
Punching this button 
will clear the entire form!
RESET BUTTON
SUBMIT
your form to Pokee's Place
Right Here
* THE OOOPS BUTTON *
However.
If you goofed up somewhere, below is your button:
If you're happy with the content of your form, you're almost finished.

Your next step is to .... 

* YOUR LAST STEP *    

* Prepare copies of your dog's vaccination, Bordetella & rabies records and  
 ensure these arrive via email (from you or your vet) prior to your dog's visit.  




Your main, #1 CELL Number: 

* SECTION I:  You & your Contact Info
* SECTION II:  All about Doggie! *arf*
* SECTION III:  Health & Veterinary Information 
MEDICATION INFO:  If your dog is on medication, is this temporary (such as an antibiotic for ear infection) OR something your dog takes every day and for what condition?
Please utilize the giant "Narrative about my Dog: text box below to give us further info if needed.       
Business/Work Phone .
*Further Required Info*  What monthly FLEA TREATMENT is your dog on? 
If you are lucky enough to live in an area without fleas and do not treat monthly, please indicate N/A.  However, environmental fleas from the beach, dune grasses, and our sandy environment in general do make an appearance every year.  Let's chat about protecting your dog from these pesky critters for their beach vacation.   
JUNE 2015 Intake Form News for New Clients:  Folks, my website host, Homestead, has experienced issues with some newly submitted Intake Forms.  We believe it is now worked out.

Until we're certain the bugs are worked out, please note:  Upon hitting the green "SUBMIT PAW" below, ensure you see a big white page with a message reading "Thank you for your form submission" and a simple BACK button.  If you see this, it will land here within minutes.  If you don't, give us a call.  Apparently, forms submitted from government servers and Window Mail are the rascals in this situation.  Thanks!  
​*Required Info*  VACCINATIONS & BORDETELLA:  
Please get your vet records out and indicate for us the date (month and year) of your dog's latest vaccination boosters *and* Bordetella.
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Our only dog
*1 of 2: First of two dogs in the family
*2 of 2: Second dog in the family
Male
Female