Registration Forms

Canine Social Club
5508 N. Western Ave., Chicago, IL 60625
Ph (773)506-6200 - Fax (773)506-6300

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New Client Registration

Please fill out your contact information.

First Name:
Last Name:
Street Address:
City/State/Zip:
Home Phone:
Mobile Phone:
Work Phone:
Email:
Spouse/Partner Name:
Spouse/Partner Phone:
Emergency Contact Name:
Emergency Contact Phone:
Emergency Contact Relationship:
Pet Name #1:
Pet Name #2:
Pet Name #3:
Pet Name #4:
Your Vet Clinic's Name::
Your Vet Clinic's Address::
Your Vet's Name:
Your Vet's Phone:
Your Vet's Fax:
How did you hear about us?:
Is your first visit for daycare or boarding?:
When do you plan on starting daycare?:
How often do you plan on using daycare?:
If boarding, when do you need to board?:

PLEASE CLICK SUBMIT BEFORE MOVING ON TO THE PET INFORMATION FORM. THANK YOU!

Detailed Pet Information

Please complete the following information for about your pet. For multiple pets, you must submit the form for each pet separately.

Owner's Name::
Your Pet's Name:
Your Pet's Gender:
Your Pet's Birth Date:
Your Pet's Breed:
Your Pet's Weight:
Your Pet's Color:
How long have you owned your pet?:
Where did you get your pet?:
Is your pet spayed/neutered?:
If no, when is it scheduled?:
Does your pet have their collar/ID?:
Is your dog micro-chipped?:
Rabies shot current?
Bordatella shot current?
Distemper/parvo shot current?
Is your dog registered with Chicago?:
Does your pet have fleas?:
Does your pet have any medical conditions?:
What medical conditions?:
Does your pet take any medications?:
What, how often & when?:
Does your dog have any allergies?:
What allergies?:
Does your pet have any restrictions?:
What restrictions?:
Does your pet get along with humans?:
Does your pet get along with other dogs?:
Is your pet fearful?:
If so, what situations?:
Has your pet ever bitten a person?:
Has your pet ever used daycare/boarding?:
Is there anything else we should know?:

JUST TWO MORE FORMS LEFT TO DOWNLOAD BELOW, PRINT AND SIGN. BRING THEM WITH YOU ON THE DAY YOU DROP OFF YOUR DOG... AND DON'T FORGET TO HAVE YOUR VET FAX OVER YOUR DOG'S VACCINATION CERTIFICATE!

Medical Release Form

(double-click to download form)

Service and Payment Form
(double-click to download form)

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