How did you hear about us?
Last Name: First Name:
Address: Home Number:
E-mail: Cell Number:
Last Name: First Name: Phone:
Name of clinic and/or doctor: Phone:
Sex: Weight: Age:
My dog is spayed/neutered:
My dog has had a contagious disease within the last 30 days?
Has your dog ever bitten another dog or person?
Please explain the circumstances.
Does your dog have food allergies?
Is your dog crate trained?
Has your dog been a family member for at least 30 days?
How long has your dog been living with you?
What else would you like us to know about your dog?
How often to you plan on using the daycare?
Completing this application puts you under no obligation to SCHROEDER'S DEN.
After receipt of your application, we will contact you to answer any questions and to
schedule a temperament evaluation or you may call us at 503-614-9899.
How would you like us to contact you?
2110 NE Aloclek Dr. Ste 620
Hillsboro, OR 97124