New Client Registration Form | Daly Dog Care

The Google SPAM test below only works with Chrome, Safari, Firefox and Microsoft Edge browsers. It will not work with Internet Explorer.

Daly Dog Care New Client Registration Form

In order to prove you're a real person (and not a SPAM bot), please check the I'm not a robot box below.

Please bring a signed copy of the downloadable rules as well as proof of Rabies, Bordetella, and DPP vaccines. Thank you can’t wait to see you!

Important: In addition to the online form below, please print the following waiver/agreement and bring it to your first appointment: Click to Print

Daly Dog Care Client Registration Form

Owner Information

First Name *Required* Required

Last Name *Required* Required

Phone Number *Required* Required

Email *Required* Required

Address

City

State | Province

Postal Code

Family Vet Clinic

How did you find us?

Emergency Contact and/or Others Allowed to Pick Up Pet(s)

Pet Information

Pet's Name *Required* Required

Breed *Required* Required

Sex *Required* Required

Color Description

Birthday

Daly Dog Care may require proof of vaccination. Upload below or bring to first appointment.

Rabies Expiration

DPP Expiration

Bordetella Expiration

—- Expiration

Microchip Code

Weight

Insurance Info

Feeding & Medication Notes

Aggressive behavior or temperament issues? (If extensive, tell us in person).

Anything else we should know? (If extensive, please tell us in person).

Pet Photo (Not Required. 5MB or smaller. Only PNG and JPG/JPEG.)

Proof of Vaccination (PDF or Image File)

Click Here to Add a Second Pet

ALERT: If you have more than two pets, submit the form once with your first two pets and then fill it out again with the information for your third and fourth pets.

Second Pet Information

2nd Pet Name *Req*

Breed *Required*

Sex *Required*

Color Description

Birthday

Daly Dog Care may require proof of vaccination. Upload below or bring to first appointment.

Rabies Expiration

DPP Expiration

Bordetella Expiration

—- Expiration

Microchip Code

Weight

Insurance Info

Feeding & Medication Notes

Aggression/temperament issues? (If extensive, please tell us in person.).

Anything else you'd like us to know?

Pet Photo (Not Required. 5MB or smaller. No PDF files. Only PNG and JPG/JPEG.)

Proof of Vaccination (PDF or Image File)

Sorry, but spammers are really smart these days. One last time, to prove you're not a robot, what does 2+2 equal?

Here's a hint: 4

If the form doesn't submit, please scroll up and make sure all required pet and owner fields are filled in. If the issue persists, send an email to support@doggiedasboard.com