Doggy Chums - Dog Boarding Emergency Information Form

Emergency Information Form

Please complete this form. It is vital the information you provide is accurate and that we can contact you when you are on holiday, or provide an alternative contact that we can speak to about your dog should an emergency/need arise.

Emergency Information, Daily Routine, Vet & Insurance form
PLEASE READ:

In this form, we will ask you information about your dog which will assist us in caring for him or her, and also give us the information we require to act swiftly should we need to, in an emergency situation. We will also ask for their habits, vet history and insurance details. When you leave your dog with us, we take great care to ensure your dog adapts to staying with our carefully selected carers.

The details you give us for your emergency contact, absolutely must be contactable at all times and be able to act in a situation where they may be required make a decision regards your dogs health, or arrange for the collection of your dog where your dog may be at risk of injury or injuring themselves. If you are not able to nominate a person, please provide the best details of how to contact you so that we may be able to act swiftly. If you have a mobile phone, please ensure it is able to work abroad and will be able to accept a call from us. We will ensure that any action taken will be in the best interests of you, and your dog based on our opinion of the situation.

Please complete the details below...
Your details
Your name *
First Name Last Name
Your E-mail *
Your nominated person in an emergency
Name of person to contact in an emergency (please inform this person before giving their name that they are an emergency contact) *
First Name Last Name
Primary phone number for the emergency contact *
Secondary phone number for the emergency contact
E-mail address for the emergency contact *

Section 2 - Health
Is your dog micro-chipped, if so, please provide the number
Does your dog have any illness'/allergies, if so please mention here:
Is your dog on any medication? *

Yes No
If yes, please provide details... (we may charge an additional fee for the administering of medication which is at the carers discretion)
Is your dog up to date with vaccinations? *

Yes No
When did he/she last have their vaccinations? *
- Day - Month Year
Is your dog up to date with Kennel Cough vaccination? *

Yes No
When did he/she last have their kennel cough vaccinations?
- Day - Month Year

Section 2 - Health
Is your dog micro-chipped, if so, please provide the number
Does your dog have any illness'/allergies, if so please mention here:
Is your dog on any medication?

Yes No
If yes, please provide details... (we may charge an additional fee for the administering of medication which is at the carers discretion)
Is your dog up to date with vaccinations?

Yes No
When did he/she last have their vaccinations?
- Day - Month Year
Is your dog up to date with Kennel Cough vaccination?

Yes No
When did he/she last have their kennel cough vaccinations?
- Day - Month Year
Please click 'Next' below

Vet information
If you are registered to a vet, please enter the details below. If you are not, please answer with a 123 in each box
Name of the vet you use *
Phone Number *

Address *

Street Address
Street Address Line 2
City	County
Postcode	Country

Insurance & Legal
We recommend you have insurance for your dog for their own health and your financial prudence. If your dog is to fall ill during their stay with Doggy Chums, this would be covered by your insurance and not that provided by Doggy Chums which is for accidents only. If a vet visit is required, we will have to charge for transport to the vets, time spent at the vets and transport back. This will be in addition to any bill the vet would give.
Do you have insurance? *

Yes No Will be obtained before we stay with you
Who is your insurance policy with?
Their telephone number
What is your policy number?

WHEN YOU HAVE CLICKED 'SEND THIS INFORMATION', YOU WILL BE TAKEN TO THE THANK YOU PAGE & YOU WILL BE SENT A COPY OF THIS FORM BY EMAIL. PLEASE PRINT THE EMAIL & BRING WITH YOU TO THE CARERS HOME, FAILURE TO DO SO MAY RESULT IN THE CARER REJECTING YOUR DOGS STAY.
Should be Empty:

Contact

If you are needing to contact us about dog boarding, please scroll up, choose a carer and click on Get a Quote. If you just want to ask us a question, please call or email us at any time, we are here to help.

Address:

Unit 6, 58 Alexandra Road, Enfield, Middlesex, EN3 7EH
+44 (0) 20 7118 0877
contact@doggychums.com
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