DOG’S NAME________________________________TODAY’S DATE_________________________________
Has your dog been boarded or in day care before?                                                     Yes___                  No___
If yes, when, where, for how long and how did he/she behave? _________________________________________________________
Has your dog been socialized with other dogs?                                             Yes___                  No___
Has your dog been socialized with men and women?                                   Yes___                  No___
Is your dog aggressive with strangers?                                                          Yes___                  No___
Is your dog aggressive on walks towards people?                                         Yes___                  No___
Is your dog aggressive on walks towards other animals?                              Yes___                  No___
Is your dog spayed or neutered?                                                                    Yes___                  No___
Does your dog have any allergies?                                                                Yes___                  No___
If yes please list them. _________________________________________________________________________________________
Is your dog on a flea treatment?                                                                     Yes___                  No___
If yes what kind. ______________________________________________________________________________________________
Has your dog been in training classes and/or private training?                      Yes___                  No___
If yes by whom, when, and for how long? ___________________________________________________________________________
Has your dog been to a dog park before?                                                      Yes ___                 No ___
How did he behave? ___________________________________________________________________________________________
PROBLEMS? Please indicate yes or no (Y or N):
Dog Aggressive__                              People Aggressive__                          Toy/Food Aggressive ___                   Chews__
Digs__                                                 Barks__                                               Runs Away__                                     Unruly__
Escapes__                                          High Jumper__                                   Shy__                                                  Afraid of Noises__
Toy Possessive__                               People Possessive__                          Separation Anxiety__                         Stool Eater__
Picky Eater__                                     House Soils__                                     Jumps Up__
Growled at someone ___                   Bitten someone ___                            Other (Explain, please) _______________________________
Knows commands ______                 List commands __________________________________________________________________
 Is there anything else we need to know about your dog? _______________________________________________________________
How did you hear about us? _____________________________________________________________________________________




                       BOARDING INFORMATION

     DATES TO BOARD           From _______________AM or AFT   To:  ___________________AM or AFT    TODAY’S DATE:____________
     OWNER                               Last Name ____________________________________ First Name __________________________________
     OWNER ADDRESS            Street____________________________________________________________________________________
                                             City ____________________________________ State _______________________ Zip _________________
     PHONES                             Home _______________________ Cell _____________________________Office_______________________
     EMAIL ADDRESS               _________________________________________________________________________________________
     EMERGENCY                     Contact _______________________________________________ Phone _____________________________
     PET INFORMATION           Name ___________________________    Breed ____________________________________ Age _________
                                              Weight ________ Color ______________________   DOB: __________   Sex: ___Spayed/Neutered circle one
     VACCINATION                    Rabies _____________________      D.H.L.P.P. _____________________      Influenza ______________
    (Please list                           Lyme ______________________      Bordetella _____________________      Fecal Exam ____________
     Expiration Dates)              
     A copy of record                 Heartworm __________________     Flea/Tick _____________________ Worming__________________
     Must be provided.                            
     VETERNARIAN   INFO      Name _______________________________________________________ Phone ____________________
     ANY HEALTH ISSUES      ________________________________________________________________________________________
     FOOD                                   Amount ___________/cups Check if applicable ___AM __PM     CAN HAVE TREATS (Yes/No) _____
     FOOD PROVIDED              BRAND________________________________________________________________________________

     ADDITIONAL SERVICES   _______________________________________________________________________________________
     NEEDED                             ________________________________________________________________________________________
     ANYTHING YOU THINK   ________________________________________________________________________________________
    All dogs must be up to date on all vaccinations or provideTiter Certificate from Veterinarian.  A copy of the medical record must be

    provided prior to boarding.  If not provided, you authorize Shadow’s Retreat to administer any necessary vaccinations and agree to pay

    the costs  (DHPP $30.00 & Bordetella $30.00).  Bordetella must have been given within the past six months, if not it will be given upon

    Shadow’s Retreat will provide your dog with a safe and secure environment and will properly feed, brush, and groom your dog as

     requested or needed.  If there is an emergency situation, your pet will be taken to your vet, if possible, or to the closest vet.  If it is an

     after hours-emergency situation, your pet will be taken to Leesburg Emergency Hospital.  Owner is responsible for any and all costs

     incurred (this includes but is not limited to injuries or illness to owner’s dog, injury or damage caused by owner’s dog to property or

     an individual, costs incurred for transportation to & from facility, etc).  By signing this form you give permission for Gene or

     Carla Robey to act on your behalf to  obtain medical care or other care as needed.  Shadow's Retreat, owners and employees,

     will exercise all due and reasonable care to prevent injury, illness, death or loss to your pet.  However, in the event of injury, illness,

     loss or death, you will not hold Shadow's Retreat or owners or employees liable for such injury, illness, loss or death under any

     circumstances. I accept cash or checks, VISA, MasterCard & Discover.  There is a 3% surcharge for using credit cards.

     There is a $35.00 fee for returned checks.  If necessary to take legal proceedings to collect a debt, the owner is responsible for

      all legal fees. The owner affirms that all facts and information regarding the Ownership of the dog, the dog’s veterinary care,

      the dog’s general health, behavior and habits, and exposure to any canine disease are true and accurate.
      By signing this form the Owner affirms that he/she has read this form in its entirety, releases Shadow’s Retreat its owners

      & employees from any and all liability and agrees with the contents.
      OWNER SIGNATURE ___________________________________________________ DATE ___________________________________


Evaluation Form

​​​​​​        Shadow's Retreat