Charlie & Chums Pet Services

Dog Walking Registration Form

One dog per form please.

About You

Owner's Name

Address

Phone

To send invoices, service agreement & future newsletters

Emergency Contact Name

Emergency Contact Number

Does your emergency contact have access to the property?

Yes

Roughly what time of day would be required?

8-11am

11-2pm

2-5pm

5-8pm

Set times aren't available so we offer a time frame for arrival.

About Your Dog

Please complete all relevant sections for your dog.

If you have multiple dogs, please fill out the form for each dog.

Name of Dog

Breed of Dog

Age & Date of Birth (If Known)

Sex

Is your dog neutered/spayed?

Yes

Is your dog microchipped?

If yes, please tell us the microchip number.

Is your dog insured?

If yes please tell us the company, policy number & expiry date.

Health Section

Please note that the information in this section will be shared with a vet if your dog requires emergency treatment whilst in our care, and therefore must be clear and accurate.

Vet Practice Name

Vet Practice Address

Vet Practice Number

Vet Practice Out of Hours Service

Please write the address & phone number of our of hours service.

Have you registered Charlie & Chums Pet Services as an approved medical decision maker with your vet?

Yes

This helps to remove any GDPR difficulties at the vet practice.

Do you agree that your dog may be taken to another (nearer) vet if the treatment required is urgent?

Yes

Is your emergency contact registered with your vet and able to make medical decisions for you?

Yes

This helps to remove any GDPR difficulties at the vet practice.

Is your dog up to date with vaccines? Including kennel cough.

If yes, please provide the date of the last vaccination

Is your dog regularly wormed and treated for flea prevention?

If yes, please provide details of the worming & flea treatment frequency.

Any medical concerns or requirements?

If yes, please provide details of your dogs medical condition.

Does your dog take regular medication?

If yes, please provide details if the dog may require medication whilst we are visiting or out walking.

Does your dog have any allergies?

If yes, please describe your dogs allergy symptoms and required treatment.

Behaviour Section

Please note that the questions in this section are used to establish the right walking experience for your dog - so please be honest. Dogs are dogs - there is no expectation of perfection.

Does your dog pull on the lead?

Is your dog unsociable (not friendly) with other dogs?

Is there anything your dog is uncertain of?

Bikes, pushchairs, children, cars etc.

Has your dog ever been aggressive towards other dogs or people?

If yes, please provide details

Has your dog ever had to wear a muzzle?

If yes, please provide details

Does your dog travel well in the car?

If no, please provide details

Where safe and appropriate, do you wish your dog to be exercised off-lead?

Yes

This is required for insurance purposes.

For off-lead: Does your dog return easily when off-lead? What is their recall command?

Yes

For off-lead: Does your dog chase wildlife/livestock?

Yes

House Section

What access does your dog have in your house when you are out?

Where are the dogs collars, leads, harnesses, treats etc kept?

Does the dog need a coat, and in which weather/temperatures?

Where should we leave them when we return?

Do you wish for us to hold a key for you?

Yes

If you do not wish us to hold a key, please tell us how we will gain access to your dog.

If you have a key safe please do not enter the details in this section. Please discuss this with me.

Does your property have an alarm?

Yes

If you have a alarm system please do not enter the details in this section. Please discuss this with me.

Additional Notes

Please inform me of any additional information you think is required here.

Declaration

I hereby confirm that I am the owner of the pet named on this form and that I authorise Charlie and Chums Pet Services to act as my pet’s guardian whilst providing the walking services.

I authorise Charlie and Chums Pet Services to take any action considered reasonable and appropriate in order to protect my pet and keep it in good physical and mental health, including admission for veterinary treatment. I further confirm that I will be responsible for unexpected costs which may be incurred relating to my pet whilst in the care of Charlie and Chums Pet Services (costs such as but not limited to veterinary care, equipment and property damage).

If my dog is unwell, and I am not able to be contacted, I give Charlie and Chums Pet Services permission to authorise emergency veterinary treatment on my behalf.

I attest that the information I have provided in this document is an accurate account of my pet’s needs and behaviour. I am aware that if my dog behaves in a manner which is dangerous to a person or another dog in Charlie and Chums Pet Services care, I will be contacted immediately and must address the issues before the commencement of further services. I undertake to keep Charlie and Chums Pet Services informed of any changes in my pet’s health, behaviour, or medical needs before making each new booking.

I agree that this consent shall remain in effect until it is superseded with a new version.

https://www.charlieandchumsmk.co.uk/termsandconditions

Can we post your dog on social media?

Yes

Feel free to follow us on socials:

Facebook & Instagram: charlieandchumspetservices

Tiktok: https://www.tiktok.com/@charlieandchums

We also have a pet supplies business!

Facebook & Instagram: charlieandchumspetsupplies

Etsy: https://www.etsy.com/shop/CharlieAndChums

Signature

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Date

Day

Month

Year