Urban Pooch Training and Fitness Center

Enrichment Intake Form

Dog Info

Please tell us about your dog(s) for which you are interested in enrolling in our Enrichment program.

Do you have an upcoming socialization test pre-scheduled with us?

Yes

Dog's Name *

Dog's Breed *

Is your dog Spayed/Neutered *

Yes

Dog's Weight *

Dog's Gender *

Male

Female

Please provide a physical description of your dog *

How long have you had this dog? *

Dog's Date of Birth (est) *

Adoption Date *

Your Vet Office *

Phone Number of Primary Veterinarian Office *

Dog's photo

Please upload your current vaccination records: *

Tell us a fun story! How did you meet your pooch?

Does your pooch have a pre-existing medical condition (i.e. injuries, scars, sensitive stomach, etc.), on medication or have any allergies? If yes, please explain. *

Has your dog ever bitten a human or displayed aggression towards humans? If yes, please explain. *

Has your dog ever bitten another dog or displayed aggression towards dogs? If yes, please explain. *

Does your pooch have any notable behavior issues of which we should be aware? Examples include leash reactivity, resource guarding, sensitivity to sound like thunder or fireworks, seperation anxiety, fear of crates, etc. *

What is your goal for Enrichment? How many days per week are you planning on using Enrichment Daycare? This allows our team to better develop a schedule for your pooch based on your goals for Enrichment!

What is your pooch's favorite toy (tug, ball, kong, chew toy, etc.)? What is your pooches favorite activity (walk, hike, swimming, napping, cuddling, etc.)?

Are there any other goals or challenges with your pooch that you would like guidance with?

Do you have a 2nd dog that you wish to enroll in our Enrichment Daycare program?

Yes

2nd Dog's Name *

2nd Dog's Date of Birth (est) *

2nd Dog's Adoption Date *

How long have you had this 2nd dog? *

2nd Dog's Breed *

2nd Dog's Weight *

2nd Dog's Gender *

Female

Male

Is 2nd Dog Spayed or Neutered? *

Yes

Does your 2nd pooch have any allergies? If yes, please detail below. *

Has your 2nd dog ever bitten a human or displayed aggression towards humans? If yes, please explain. *

Has your 2nd dog ever bitten another dog or displayed aggression towards dogs? If yes, please explain. *

Does your 2nd dog have any notable behavior issues of which we should be aware? Examples include leash reactivity, resource guarding, sensitivity to sound like thunder or fireworks, seperation anxiety, fear of crates, etc. *

2nd dog: What is your goal for Enrichment? How many days per week are you planning on using Enrichment Daycare? This allows our team to better develop a schedule for your pooch based on your goals for Enrichment! *

2nd Dog: What is your pooch's favorite toy (tug, ball, kong, chew toy, etc.)? What is your pooches favorite activity (walk, hike, swimming, napping, cuddling, etc.)? *

2nd Dog: Are there any other goals or challenges with your pooch that you would like guidance with? *

2nd Dog: Photo

2nd Dog: Please upload your current vaccination records:

Do you have a 3rd dog that you wish to enroll in our Enrichment Daycare program? *

Yes

3rd Dog: Name *

3rd Dog: Breed *

3rd Dog: Gender *

Male

Female

3rd Dog: Weight *

3rd Dog: Spayed or Neutered?

Yes

3rd Dog: Please provide a physical description of your dog *

3rd Dog: Tell us a fun story! How did you meet your pooch?

3rd Dog: Has your dog ever bitten a human or displayed aggression towards humans? If yes, please explain. *

3rd Dog: Has your dog ever bitten another dog or displayed aggression towards dogs? If yes, please explain. *

3rd Dog: Does your pooch have any notable behavior issues of which we should be aware? Examples include leash reactivity, resource guarding, sensitivity to sound like thunder or fireworks, seperation anxiety, fear of crates, etc. *

3rd Dog: What is your goal for Enrichment? How many days per week are you planning on using Enrichment Daycare? This allows our team to better develop a schedule for your pooch based on your goals for Enrichment! *

3rd Dog: What is your pooch's favorite toy (tug, ball, kong, chew toy, etc.)? What is your pooches favorite activity (walk, hike, swimming, napping, cuddling, etc.)? *

3rd Dog: Are there any other goals or challenges with your pooch that you would like guidance with? *

3rd Dog: Photo

3rd Dog: Please upload your current vaccination records:

Date *

Signature *

Clear

I have read the section above concerning vaccine requirements and I will abide by said rules. *

Yes

IN CASE OF MEDICAL EMERGENCY: *

I authorize Urban Pooch and/or their designated representatives to take my dog to the nearest professional veterinarian and authorize treatment. I understand all costs in connection with this emergency treatment, including transportation, veterinary, medications, and other costs necessary for this care will be my responsibility. I am providing Urban Pooch with credit card information to be used for such purposes. I understand that although all client dogs are domesticated and under constant supervision, an injury to my dog might occur, in which event, I release Urban Pooch, Inc. and its owners and staff of any and all liability, financial and otherwise, which arise in any way from services and/or products provided or as a consequence of my association with Urban Pooch. I waive any and all claims, actions, or demands of any nature, foreseen unforeseen, that I may have against Urban Pooch relating to the care, control, health and/or safety of my dog arising during drop-off, pick-up, transport, and stay at Urban Pooch facilities.

If you are interested in your dog getting an outdoor walk during their enrichment sessions, please check yes. *

Yes

Rules for Participation in Enrichment Daycare *

Health Records Policy: All dogs must have current vaccinations. A negative fecal test is required every six months. Owners must provide written proof that each dog has received Rabies, Distemper/Parvo DHLLP or DA2CPV, Bordetella, and H3N2 Flu Vaccine prior to receiving services.

Spay/Neuter Policy: I acknowledge that all dogs 8 months or older must be spayed/neutered in order to participate in our enrichment/daycare/boarding programs. If my dog is a current participant in these programs, then by the age of 8 months they must either be spayed/neutered or else take a break from these programs until they are spayed/neutered. Additionally, if my dog is absent from these programs for more than 6 months for whatever reason including the state of their spay/neuter, then they must complete a re-socialization appointment in order to rejoin said programs. This re-socialization session must be pre-scheduled via our front desk.

Canine Health Policy: All dogs must be in good health and free of any communicable disease. If you notice any vomiting, diarrhea, gaging, coughing, and/or any other symptoms, please DO NOT bring your dog to daycare. Dogs with any of these symptoms will not be admitted to daycare. If Urban Pooch notices any of these symptoms in your dog, you will be notified to pick up your dog immediately. If Urban Pooch cannot reach you, your dog will be placed in isolation. If necessary, your dog will be examined by a veterinarian and you will be charged accordingly. If your dog has been ill in the past 30 days, please inform Urban Pooch staff.

License: All dogs must have a City of Chicago dog license. An online application receipt will suffice.

Food/Treat Policy: If owners do not provide treats themselves, then UPTFC will utilize Vital Essential brand treats for your dog during enrichment sessions. If you are concerned about allergies, overfeeding or stomach senstivity, please make sure to bring your own treats pre-labeled (dog's first and last name) and bagged.

Medication Policy: Each dog’s medication must be labelled with dog’s first/last name and specific instructions should be provided.

Socialization Test Policy: Every dog will be evaluataed prior to genreal admission via a half-day enrichment daycare socialization process. Dogs that have not attended enrichment for more than six months must be re-socialized. There is a $40 nonrefundable socialization fee required to book an appointment.

First Name *

Last Name *

Phone *

Email *

Additional Parent

Additional Parent's Phone Number

Emergency Contact Name & Number (Not an owner): *