1 Owner Information2 Pet Information3 Special Needs4 Pet Personality5 Agreement Owner InformationName* First Last Home PhoneCell Phone*Work PhoneEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Veterinary Clinic Name*Clinic Phone*Veterinarian Name First Last How did you hear about us?* Buzz Magazine Friend Referral Yelp Houston Pet Talk Veterinarian Internet Search Other If you were referred by a friend, please let us know who we can thank in the "Referred by" field below.Referred by:How many dogs are you registering today?*123456 Pet InformationPet Name*Pet 2 Name*Pet 3 Name*Pet 4 Name*Pet 5 Name*Pet 6 Name*Pet Birth Date* Date Format: MM slash DD slash YYYY Pet 2 Birth Date* Date Format: MM slash DD slash YYYY Pet 3 Birth Date* Date Format: MM slash DD slash YYYY Pet 4 Birth Date* Date Format: MM slash DD slash YYYY Pet 5 Birth Date* Date Format: MM slash DD slash YYYY Pet 6 Birth Date* Date Format: MM slash DD slash YYYY Pet Gender* Male Female Neutered Spayed Pet 2 Gender* Male Female Neutered Spayed Pet 3 Gender* Male Female Neutered Spayed Pet 4 Gender* Male Female Neutered Spayed Pet 5 Gender* Male Female Neutered Spayed Pet 6 Gender* Male Female Neutered Spayed Pet Breed*Pet 2 Breed*Pet 3 Breed*Pet 4 Breed*Pet 5 Breed*Pet 6 Breed* Special Needs/CertificationsSpecial Needs/Important Info*If you don't need to share any additional information about your dog(s), please enter "None" here.By clicking "I agree" you certify that your dog(s) are in good health and have not had any communicable diseases in the past 30 days.* I AGREE I DO NOT AGREE By clicking "I agree" you certify that your dog(s) have never bitten, snapped, harmed, or shown aggressive behavior toward any person or other dog.* I AGREE I DO NOT AGREE Pet Personality InfoHas your dog ever stayed at a boarding facility or veterinary clinic?* Yes No If yes, how often does your dog board? 0-2 times per year 3-5 times per year 6 or more times per year Does your dog enjoy boarding?* Yes No Is your dog housetrained?* Yes No Does your dog have sensitivity to thunder or loud noise?* Yes No Does your dog know how to use a dog door?* Yes No Does your dog have issues with men?* Yes No How does your dog react to unfamiliar people?In your home:*If multiple dogs, please specify for each dog.In public:*If multiple dogs, please specify for each dog.Does your dog have food allergies?* Yes No Does your dog have any other allergies?* Yes No Is your dog prone to hotspots?* Yes No Does your dog have any health issues/concerns or physical limitations?* Yes No If yes, please describe:Does your dog have frequent diarrhea or a sensitive stomach?* Yes No If yes, please describe:Does your dog jump/climb fences?* Yes No Has your dog ever shown aggression toward a human?* Yes No If yes, please describe:Has your dog ever bitten a person?* Yes No If yes, please describe:Has your dog ever shown aggression toward a dog?* Yes No If yes, please describe:Has your dog ever bitten a dog?* Yes No If yes, please describe:When your dog is on leash, does he/she bark or lunge at other dogs or people?* Yes No When your dog is behind a fence, does he/she bark or lunge at other dogs or people?* Yes No Does your dog have issues being handled?* Yes No What brand of food does your dog eat?*Is your dog on a monthly flea/tick preventative?* Yes No Is your dog comfortable being groomed?* Yes No Primary Emergency Contact InformationIn the event of an emergency, please contact me (or my dog(s) other owner when applicable) as follows:First*Second*ThirdSecondary Emergency Contact InformationBelow please list names and phone numbers for people you would like Houston Dog Ranch to contact in the event that you are unreachable in an emergency situation.Alternate Emergency Contact #1:* First Last Alternate Emergency Contact #1 Phone:*Alternate Emergency Contact #2:* First Last Alternate Emergency Contact #2 Phone:*EMERGENCY CARE PERMISSIONConsent* I consent to the emergency care policy as outlined below.I give Houston Dog Ranch permission to take my dog(s) to the nearest animal hospital for care/treatment IN CASE OF EMERGENCY. Houston Dog Ranch has my permission to administer or arrange for any care/treatment deemed necessary. I will be solely responsible for all payments, in full, for any veterinary or other care/treatment provided for my dog(s). I also understand that in the case of SEVERE emergencies, treatment may be required before I am contacted.AGREEMENTTerms of Service* I agree to the terms of service.