Cani

ne S

ocia

l Clu

b

178 S. Charlotte St

Asheville, NC 28801

of A

shev

ille

socialclub@csahmail.com 828-774-5668

Temperament Test 178 South Charlotte St

Date/Time: Asheville, NC 28801

Small/Large Dog Room (828) 774-5668

Pass/Fail/Revisit in future

Application continues on back

Owner/Guardian Information

Name:

Address:

City: State: Zip: Email:

Primary Contact Phone #1: Phone #2:

Secondary Contact Phone #1: Phone #2:

How did you hear about us? ⃝ Drive By ⃝ Website ⃝ Facebook ⃝ Referral*

*Please let us know who we can thank:

Social Club Canine Member – Self and Genetics

All dogs must be spayed or neutered by 6 months of age.

Pet’s Name: Date of Birth:

Breed: Sex: ⃝ Male ⃝ Female Spayed/Neutered: ⃝ No ⃝ Yes

Pre-Existing Medical Conditions: ⃝ No ⃝ Yes: (Please describe)

Food Allergies: ⃝ No ⃝ Yes: (Please describe)

Primary Veterinarian and Clinic Name: Phone Number: City/State:

In addition to the guardian above, which other humans are approved to pick up?

Human 1: Phone #:

Human 2: Phone #:

Has your pet had any communicable disesases or conditions in the past 60-90 days?

⃝ No ⃝ Yes: (Please describe)

Has your pet had a cough, diarrhea or vomitting in the past 60-90 days? (Circle options as applicable)

Does your pet have any disabilities, allergies or restrictions?

⃝ No ⃝ Yes: (Please describe)

Does your pet receive routine flea control and/or heartworm prevention? ⃝ No ⃝ Yes

Product Name: Last dose given on: / /

Product Name: Last dose given on: / / **If fleas are found on your pet, we will provide appropriate treatment as directed by our veterinarian. See Canine Social Club waiver form for further details. Does your pet take any medications prescribed by a veterinarian? ⃝ No ⃝ Yes

If yes, will your pet need any medications during their stay today? ⃝ No ⃝ Yes***

List medication(s), dosages and timeframes to be given:

Optional Mealtime Would you like us to feed your pet during their stay today? ⃝ No ⃝ Yes***

If yes, what food does your dog nromally eat? ⃝ Store bought ⃝ Prescription diet only

Preferred food type: ⃝ Dry/Kibble ⃝ Moist/Canned ⃝ Refrigerated/Raw

When should we give their food: ⃝ 10:30am ⃝ 12pm ⃝ 3:30pm Amount:

***Please bring any medications or food needed from home

Application continues on next page

Family, Home & Lifestyle – Environment

How long have you been with your dog? ⃝ Months ⃝ Years

Do you live in a house, condo or apartment?

How much time does your dog spend outside daily?

Do you walk/play with your dog daily? For how long?

How many hours a day is your dog home alone (without humans)?

Is your dog comfortable with your absences or destructive/anxious when you are away?

Please check the option that best describes your pet’s daily routine:

⃝ Goes to work with parent ⃝ Outside for majority of day

⃝ Crated when parent is away ⃝ Stays in a fenced-in yard

⃝Free reign of household ⃝ Access to doggie door, house and yard

Do you take your dog lots of places with you?

How many people live in your home?

Are there children? What ages?

Are there other animals in the home? What kind and how old?

How does your dog get along with the people and animals in the home? Have there been any stresses or problems between them?

How does your dog react when he/she meets other dogs or people while on leash?

Please check the options that best describe your dog’s general temperament: ⃝ Playful ⃝ Excitable ⃝ Friendly ⃝ Shy ⃝ Dominant ⃝ Anxious

Has your dog experienced any changes in your home or routine recently?

Life Experiences and Education – Learning

Is your dog house-trained? ⃝ Yes ⃝ No ⃝ Inconsistent: (please specify)

How does your dog react to other dogs?

How does your dog react to strangers?

Do you use any other daycare environment for your dog, or have you in the past? ⃝ No ⃝ Yes

If yes, how did it go?

Is there anything your pet fears or dislikes? ⃝ No ⃝ Yes:

Has your dog ever growled or snapped at anyone over food, treats or toys? ⃝ No ⃝ Yes

If yes, under what circumstance?

Has your dog ever bitten any person or any animal?

If yes, under what circumstance?

Does your dog have any challenges in the following areas?

⃝ Territorial Marking ⃝ Leash Aggression ⃝ Chewing ⃝ Snarling

⃝ Barking ⃝ Separation Anxiety ⃝ Jumping ⃝ Lunging

⃝ Escape Artist ⃝ Not leash trained ⃝ Guarding ⃝ Snapping/Biting

Has your dog had any formal obedience training? ⃝ No ⃝ Yes:

What verbal commands or hand signs does your dog know?

What skills are you currently working on? What commands do you use?

Does your dog like to play with toys? ⃝ No ⃝ Yes:

Is your dog food motivated? ⃝ No ⃝ Yes

What treats may we give your dog today? ⃝ Treats from home only*

⃝ Peanut Butter & sweet potato kong ⃝ Science Diet Sensitive Stomach Kibble ⃝ Freeze Dried Liver

*If not allowed our kibble or liver treats, please bring treats from home for puzzle time

What are your dog’s MOST favorite petting spots?

Are there any areas we should avoid touching or petting?

Please explain your interest in the Canine Social Club program and goals for your dog:

Today’s Date: _________________

Print Name of Owner/Legal Guardian: _________________________________

Signature of Owner/Legal Guardian: ___________________________________

Canine Social Club of Ashville Waiver

I, _____________________________________________, hereby certify that my

dog(s)__________________________________________________________________ is/are in good

health, on monthly flea and intestinal worm prevention (12 months a year) and have not been ill with

any communicable condition in the last 30 days. I further certify that my dog(s) have not harmed or

shown aggressive or threatening behavior towards any person or any other dog.

I have read and understood the following:

I understand that I am solely responsible for any harm or damage caused by my dog(s) to persons or

property of the Owners, employees, licensees, invitees of The Canine Social Club of Asheville, or any

other club members.

I further understand and agree that in admitting my dog(s) to the Social Club, the Canine Social Club of

Asheville Staff have relied on my representation that my dog(s) is/are in good health and have not

harmed or shown aggressive or threatening behavior towards any person or any other dog.

I further understand and agree that, The Canine Social Club of Asheville and their staff and volunteers,

will not be liable for any problems which develop, provided reasonable care and precautions are

followed, and I hereby release and discharge them of any and all damages, liability and/or causes of

action of any kind of accident, damage or injury whatsoever arising from my dog(s) attendance and

participation at the club.

I further understand that in the event that any medical problem or injury develops with my club

member a staff member of the Canine Social Club of Asheville will attempt to contact all available

persons given in the member profile. In the event no one can be contacted I consent to let the

veterinarians and staff at Charlotte Street Animal Hospital provides medical treatment to my dog. I

agree to assume full financial responsibility for any and all expenses involved in such treatment.

I recognize that there are inherent risks of illness or injury when dealing with animals. Such risks include,

but are not limited to, problems resulting from rough play and canine cough (doggie colds). Please be

aware that your dog might show signs of fatigue as well as soreness from excessive playing.

I am aware that my dog will co-mingle with dogs owned by different owners while visiting the Canine

Social Club of Asheville. I certify that I have read, understood and agree with the policies of the Social

Club as set forth on the preceding pages and that I have read, understood and agree with the conditions

and statements of this agreement.

Signature of

Owner:____________________________________________________Date:______________ Name of

Owner: (Print)_____________________________________________________________________

Canine Social Club of Asheville Cancellation Policy

We maintain small groups of dogs in our space each day to keep the environment safe and constructive.

We often have a waiting list of dogs that would love to take a spot that becomes available. However,

they need adequate notice to do so. To best honor all our clients, we require 24-hour notice of

cancellation. Exceptions will be made in the case of emergency situations.

Failure to give 24-hour notice of cancellation will result in full charge for the scheduled daycare visit.

If you have questions about the days your dog is scheduled, check the calendar in your Pet Exec portal.

I, _______________________, have received and understand the terms of the cancellation policy and

understand my responsibility to plan accordingly.

_________________________________________________ _________________________

Signature Date

Navigating Pet Exec

Pet Exec is our online system for managing all of our families’ files. Once your pup has passed their

temperament test, you’ll receive an email with your login information. From your portal you’ll then be able to

request daycare visits, view your dog’s scheduled daycares, cancel previously scheduled days, edit information

and make payments.

To access Pet Exec you can either go directly to their site www.petexec.net or login on the bottom right corner

of any page on our website www.caninesocialclubofasheville.com. There’s even an app you can download for

your phone!

The following instructions begin on your Pet Exec dashboard. The pictures were taken on a phone, so the

layout of the buttons will appear differently on a desktop.

Request a daycare visit:

Use the drop down boxes to select full

or half day (half day is the default) and

indicate the hours by choosing either

7am-6pm for full day, 7am-12pm for

just AM, or 1-6pm for just PM. Know

that the 12-1 hour is the drop

off/pickup grace period for half day

attendance. Selecting the hours listed

just helps us to quickly differentiate

attendance numbers throughout the

day.

Confirmation of requested days:

Always check the confirmation emails

for the dates and times that were

actually scheduled. A received request

doesn’t guarantee availability in our

schedule.

These pictures show an example of

someone requesting a whole week of

full days. Only certain days/times were

available for scheduling. The email

confirmation shows two approved full

days and one half day. If it turns out

that you don’t want the half day, or find

an alternate option that can cover the

whole week, you can always delete

those days.

Canceling/Deleting scheduled daycare:

The calendar shows you

all of the days that your

pet is scheduled for

daycare. Clicking on the

individual reservations

(blue icon) shows

whether this is a full,

AM or PM visit.

Update vaccine information:

Current vaccines are required in order to request daycare scheduling. PetExec doesn’t communicate with any

animal hospital, so we need to know when your dog has updated vaccines. An easy way to give us that

information is to scan or take a picture of the most recent veterinary records and do a file upload. We receive

a notification anytime a file is uploaded so we can then plug those new dew dates into your dog’s vaccine

records on PetExec. You can also use this tool to upload notes from a trainer, identification information for

pet sitters, etc.

Online Payments: