Daycare Enrolment Form

Size: px
Start display at page:

Download "Daycare Enrolment Form"

Transcription

1 Daycare Enrolment Form Office Use Only Enrolment Form Vaccination Record Signed Waiver Social Assessment Computer Entry First Day: How did you hear about WAG Canine? Contact Information Owner Information Address: Home Ph: Work Ph: Cell: Emergency Contact Home Ph: Work Ph: Pet Information Breed: Sex: Weight: Birthdate: Spayed/Neutered Yes No Age procedure completed: Veterinarian Address: Ph: Fax: Health and Grooming Does your dog have a problem with fleas? Yes No Allergies? Yes No Does your dog have hip dysplasia? Yes No Any other physical conditions? Yes No If yes, what restrictions need to be placed on your dog s activities or movements? Has your dog experienced any form of illness in the last 14 days? Yes No If yes, please describe: Does your dog like to be brushed? Yes No How does your dog react to having his/her nails clipped? Does your dog have any sensitive areas on his/her body? Where are your dog s favorite petting spots? Does your dog require administration of any regular medications? Yes No Form attached? Yes If your dog has any health or behavioural concerns that require further explanation, please attach another page to this document. If your dog s health or behaviour changes while attending our facility you are required to inform the staff of WAG Canine immediately.

2 Does your dog react to, or act afraid of, any specific items or noises? If so, please explain: Has your dog ever growled at another person or dog? If so, what were the circumstances: How does your dog react to strangers coming into your home or yard? Has your dog ever bitten another person or dog? If so, what were the circumstances: How does your dog react to anyone passing outside your home or yard? Are there any kinds of dogs your dog automatically fears or dislikes? Are there any kinds of people your dog automatically fears or dislikes? Does your dog have any problems in any of the following areas: (if so, please explain) Mouthiness: Yes No Housetraining: Yes No Barking: Yes No Digging: Yes No Describe how your dog greets other dogs when on leash. Jumping: Yes No Other: Yes No Has your dog ever jumped a fence, gate or barrier that was intended to keep him/her contained? Yes No Describe how your dog greets other dogs when off leash. How does your dog react to puppies? Has your dog ever shared food or toys with other animals? Yes No What training have you done with your dog? (i.e home training, web based, formal classes) Have you ever used a kennel/crate at home now or in the past? If yes, how did they react when you leave, when and how often do (did) you use it? What opportunities does your dog have to play off leash with other dogs? What kind of toys does your dog like and what games does he/she play? What commands does your dog know? What kind of food are you feeding your dog? Has your dog ever been to dog daycare before and, if so, why are they not going there now? Where did you get your dog? Date you acquired your dog: If adopted, do you have any knowledge of your dog s past history? Are there any other animals in your household? (list type, sex and age of each) How does your dog get along with other animals in your home? I hereby certify that, to the best of my knowledge, the above information is a true and correct accounting of my dog s health, history and behaviour. Signature Date

3 WAG Daycare Policies and Waiver The purpose of WAG Canine Recreation Centre ( WAG Canine ) and its daycare program ( daycare ) is to provide a safe, fun and stimulating social environment for dogs during weekday business hours. To ensure the safety and health of your pet and our other guests, we require all guests to comply with the following rules and regulations: AGE: All dogs that are enrolled in daycare must be at least 12 weeks of age or older. SEX: All dogs 6 months or older that are enrolled in daycare must be spayed or neutered. VACCINATIONS: All dogs that are enrolled in daycare must have up-to-date vaccinations. Owners must submit written proof of DHPP and Bordetella vaccinations. Rabies vaccination is required for puppies that are enrolled in daycare and over 4 months of age. HEALTH: All dogs must be in good health. By signing this form, I certify that my dog is in good health and has not been ill with a communicable condition in the last 14 days. Upon admission, all dogs must be free from any condition which could potentially jeopardize other guests including but not limited to ticks and fleas. Dogs that have been ill with a communicable condition in the last 14 days will require veterinarian certification of health to be admitted or readmitted. I understand that I am required to inform daycare staff of any recent changes in my dog s health or behaviour when placing my dog in the care of daycare staff. FOOD: The daycare program does not include feeding. I understand that if I want my dog to be fed I must provide a container of appropriate food marked with my dog s name and feeding instructions. COLLARS: All dogs must wear a flat, close fitting collar with no chains or metal studs. Certain collars can create a hazard when dogs play together. Loose fitting collars (such as martingale collars) and collars made of chain can entrap another dogs jaw or teeth during play and potentially cause injury to one or both dogs. WAG Canine Recreation Centre requires all dogs to wear a flat collar with a quick release fastener that is snug to the dog's neck to minimize these concerns and create a safe environment for all our guests. BEHAVIOR: All dogs must be non-aggressive and not food or toy protective. By signing this form, I certify that my dog has not harmed or shown any aggressive or threatening behaviour towards any person or any other dog. Please remember: your pet will be spending time with other pets and the safety and health of all animals is the daycare staff s main concern. PHOTOGRAPHS AND VIDEO: By signing this form, I agree to allow daycare staff to take photographs and/or video of my dog while attending daycare or receiving other services on the premises of the daycare. I also agree to allow daycare staff to use my dog s name and any image or likeness of my dog taken while on the premises of the daycare in any form or format, for use, at any time, in any media, advertising, illustration, trade, or promotional materials. PERSONAL PROPERTY: I agree that WAG Canine, its owners and staff shall not be responsible or liable for any lost, stolen or damaged personal property belonging either to me or my dog while on the premises of WAG Canine. I also understand that a dog collar may be removed in the play area to prevent injury to any dog. If my dog causes any damage to the daycare facilities or equipment, I agree to be fully responsible for the full cost of any repair or replacement. AGRESSIVE DOGS: I certify that my dog is not aggressive. I understand that aggressive dogs are not permitted to attend WAG Canine s daycare program and that if my dog acts aggressively or exhibits unacceptable behaviour he/she may be separated from the other dogs. Daycare staff will use reasonable efforts to consult with dog owners about aggression and ways to address it, however, aggressive dogs may be asked not to return to WAG Canine. Such determinations shall be made at the sole discretion of WAG Canine Recreation Centre. ENROLMENT FORM: All dogs must have a complete, up-to-date and approved enrolment form on file.

4 FEES: Fees are based on a daily rate for full or half days. A full day is not to exceed 10.5 hours. A half day is not to exceed 5 hours. Additional dogs from the same household receive a discounted rate for daycare attendance. Please refer to fee schedule for a complete price list. DAYS AND HOURS: WAG Canine is open Monday through Friday from 7:30 a.m. to 6:00 p.m. WAG Canine is not an overnight facility. Staff go off duty at 6:00 p.m. and there is a $5.00 late charge for every 10 minutes (or part thereof) after 6:00 pm that your dog is still in our care. Late charges must be paid when retrieving your dog from WAG Canine. DUTY TO DISCLOSE: I have disclosed and understand that I have a responsibility to continue to disclose on an ongoing basis, any and all medical or other conditions, including but not limited to personality concerns or behaviours that may affect, limit or prevent my dog s ability to participate in play, or otherwise attend WAG Canine s daycare program. VETERINARY CARE: I agree to allow WAG Canine, its owners and staff, to obtain medical treatment for my dog, if it appears that my dog is ill, injured or exhibits any other behaviour that would reasonably suggest that my dog may need medical treatment. I AGREE THAT I AM FULLY RESPONSIBLE FOR THE COST OF ANY SUCH MEDICAL TREATMENT, AND FOR THE COST OF ANY TRANSPORTATION FOR THE PURPOSES OF OBTAINING SUCH TREATMENT, PROVIDED TO MY DOG. ABANDONED DOGS: I understand that any dog left in the care of WAG Canine after 8:00 pm without contact or instruction from the dog s owner will be considered abandoned. Abandoned dogs will be turned over to the Town of Amherst as stray dogs. RESERVATIONS: Reservations are highly recommended. WAG Canine cannot guarantee a space for any dog on a walk in basis. Cancellations with less than 12 hours notice and failure to show for a reservation will be subject to additional fees. Please refer to the Cancellation, No Show and Late Pick up policy for more details. I hereby certify that I have read, understood and agree to abide by all of the policies, rules and regulations contained within this document. Signature Date

5 OWNER LIABILITY WAIVER AND HEALTH CERTIFICATION OWNER AGREEMENT I,, hereby certify that my dog: is in good health and has not been ill with any communicable condition or illness in the last 14 days. I further certify that my dog has not harmed or shown aggressive or threatening behaviour towards any person or any other dog. I have read and understand the following: 1. I understand that I am solely responsible for any harm caused by my dog while my dog is attending WAG Canine Recreation Centre ( Centre ). 2. I further understand and agree that in admitting my dog to the Centre, WAG Canine Recreation s staff have relied on my representation that my dog is in good health and has not harmed or shown aggressive or threatening behaviour towards any person or any other dog. 3. I further understand and agree that WAG Canine Recreation Centre and their staff and volunteers, will not be liable for any problems that develop, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog s attendance and participation at the Centre. 4. I further understand and agree that dogs can sometimes receive minor cuts and scratches at daycare and any problems that develop with my dog will be treated as deemed best by staff and volunteers of WAG Canine Recreation Centre, at their sole discretion, and that I assume full financial responsibility for any and all expenses involved. I certify that I have read and understand the policies of the Centre as set forth in the preceding paragraphs and that I have read and understand the conditions, and statements of this agreement. Dated: Signature of Owner:

Daycare & Sleepover Registration Form

Daycare & Sleepover Registration Form Dog s Name Dog s Birthday Daycare & Sleepover Registration Form Owner(s) Information Name(s): Address: City: Postal Code: Home Phone: Cell: Business: Email: Emergency Contact Name: Address: Email: Home

More information

Bed & Biscuit, Inc. Doggie Daycare and Boarding. Name: Address: City: State: Zip Code: Home Phone #: Work #: Cell #

Bed & Biscuit, Inc. Doggie Daycare and Boarding. Name: Address: City: State: Zip Code:   Home Phone #: Work #: Cell # Doggie Daycare and Boarding FOR OFFICE USE ONLY Enrollment Form Shots Staff Screened Computer Entry Folder Made First Day EMERGENCY CONTACT INFORMATION Owner Information Name: Address: City: State: Zip

More information

Enrollment Form, Pet Profile and Liability Release. Enrollment Form

Enrollment Form, Pet Profile and Liability Release. Enrollment Form Enrollment Form, Pet Profile and Liability Release A completed Enrollment Form and Pet Profile must be submitted for each pet attending Timberlane Pet Hospital & Resort before an interview is scheduled.

More information

Veterinary Group of Chesterfield Edison Ave., Chesterfield, MO

Veterinary Group of Chesterfield Edison Ave., Chesterfield, MO Veterinary Group of Chesterfield Daycare/Boarding Playtime Requirements Our guidelines are set forth to ensure the health and safety of all daycare participants. All dogs over 6 months of age must be spayed

More information

Daycare Application Form

Daycare Application Form Daycare Application Form TGDS Staff Use Only Evaluation Date: Application Complete: Liability Waiver Signed: Vaccinations Verified: Please submit the completed Application, signed Liability Waiver and

More information

Doggie Daycare/Boarding Application

Doggie Daycare/Boarding Application Doggie Daycare/Boarding Application Date of Application: Dates of Daycare or Boarding: OWNER S INFORMATION: Name: Address: City/State/Zip: E-Mail Address: Home phone: Cell / Work phone: Persons allowed

More information

3 DOGS BOARDING AND DAYCARE

3 DOGS BOARDING AND DAYCARE 3 DOGS BOARDING AND DAYCARE Owner Information Name Address City, State, Zip Email *Would you like to be added to our email list for daycare/boarding updates and availability? Yes No (this list is for our

More information

AllBreed s Canine Care Application

AllBreed s Canine Care Application AllBreed 2357 Ventura Drive, Ste 102 Obedience & Woodbury, MN 55125 Behavioral school for dogs www.allbreedobedience.com AllBreed s Canine Care Application 651/704-9785 em: Aobedience.aol.com PLEASE PRINT

More information

All dogs must be at least 8 weeks of age or older. All dogs 7 months or older must be spayed or neutered.

All dogs must be at least 8 weeks of age or older. All dogs 7 months or older must be spayed or neutered. GENERAL INFORMATION AND POLICIES Purpose: Sunny Acres Pet Resort Doggy Day Camp provides a safe, fun and stimulating social environment for dogs. To ensure the safety and health of your pet and our other

More information

Dog Daycare. Pet Profile Enrollment Form. K-9 Kamp Downer Street Rd. Baldwinsville, NY Phone:

Dog Daycare. Pet Profile Enrollment Form. K-9 Kamp Downer Street Rd. Baldwinsville, NY Phone: K-9 Kamp Dog Daycare Pet Profile Enrollment Form Please return this completed form along with a copy of your pet(s) vaccination records to: K-9 Kamp 228 Old Bridge Street East Syracuse, NY 13057 -OR- 2115

More information

Age: All dogs must be at least 16 weeks or older. Puppies and shelter dogs must have been at home for 2 weeks prior to coming to daycare.

Age: All dogs must be at least 16 weeks or older. Puppies and shelter dogs must have been at home for 2 weeks prior to coming to daycare. Dogs @ Play Daycare Requirements To ensure the health and safety of your pet and of our other guests, we require that all of our clients comply with the following rules and regulations. Age: All dogs must

More information

PLEASE KEEP THIS PAGE FOR YOUR RECORDS

PLEASE KEEP THIS PAGE FOR YOUR RECORDS General Information about All Pets Dog Daycare DOGS ALL dogs must pass a temperament test prior to their first day of daycare. Temperament tests generally last 1 hour and an appointment is REQUIRED for

More information

Emergency Contact Name Address Home phone Cell phone

Emergency Contact Name Address Home phone Cell phone 3606 NE Columbia Blvd. Portland OR 97211 email: staypetreservations@gmail.com Phone: 503-288-7829 Fax: 503-288-8374 Owner Information Name Address City, State, Zip Email Cell phone Work Phone Home phone

More information

Daycare Application Form

Daycare Application Form Daycare Application Form To help ensure the health and safety of your dog and those already in our care, Please provide as much detailed information as possible throughout the application form. Owner details

More information

PLAY ALL DAY, LLC REGISTRATION FORM

PLAY ALL DAY, LLC REGISTRATION FORM Today s Date: How Did You Hear About Us? Owner(s) Name(s) Home Address City, State, Zip PLAY ALL DAY, LLC REGISTRATION FORM Start Date: OWNER INFORMATION Home Phone ( ) Work Phone ( ) Cell Phone ( ) Other

More information

The Barking Orange Daycare Application (Updated September 2015)

The Barking Orange Daycare Application (Updated September 2015) The Barking Orange Daycare Application (Updated September 2015) Contact & General Information Your Name Street Address City, State, ZIP Code Home Phone Cell Phone Work Phone E-Mail Address How Did you

More information

APPLICATION. Cell phone.

APPLICATION. Cell phone. 333 North Bedford Road Mt. Kisco, NY 10549 Phone: 914-218-8258 Fax: 914-218-8259 Website: ckatthepark.com APPLICATION Owner Information Name Address Date Home phone Work phone Cell phone Email Services

More information

MEMBERSHIP APPLICATION

MEMBERSHIP APPLICATION NoDa Bark and Board MEMBERSHIP APPLICATION Today s date: OWNER INFORMATION: (Please print) Name: Address: City: _ State: Zip: Home Phone: _ Cell: _ Employer: _ Work Phone: E-mail Address: EMERGENCY CONTACT:

More information

INN OF THE DOG. 865 S.W. Enterprise Way, Stuart, FL (772) Fax: (772) Innofthedog.com. Home Phone ( ) Cell Phone ( )

INN OF THE DOG. 865 S.W. Enterprise Way, Stuart, FL (772) Fax: (772) Innofthedog.com. Home Phone ( ) Cell Phone ( ) INN OF THE DOG 865 S.W. Enterprise Way, Stuart, FL 34997 (772) 288-1998 Fax: (772) 288-4338 Innofthedog.com 1 Owner Information Name Street Address City/State/Zip Home Phone ( ) Cell Phone ( ) E-mail address

More information

DOG DAYCARE APPLICATION FORM

DOG DAYCARE APPLICATION FORM DOG DAYCARE APPLICATION FORM How Did you Hear About Us? Your Name: Address: Postal Code Home Phone ( ) - Work ( ) Cell: ( ) Email Address: If we can t get in touch with you who can we call? (Emergency

More information

YOUR NAME: ADDRESS: HOME PHONE: WORK PHONE: CELL PHONE: DOG S NAME: AGE: BREED:

YOUR NAME: ADDRESS: HOME PHONE: WORK PHONE: CELL PHONE:   DOG S NAME: AGE: BREED: MEDICAL RELEASE FORM YOUR NAME: ADDRESS: HOME PHONE: WORK PHONE: CELL PHONE: EMAIL: DOG S NAME: AGE: BREED: THIS IS A REQUIRED FORM FOR ALL SALTY DOG DOGGY DAYCARE PARTICIPANTS RECEIVING SERVICES. First

More information

Woofgang s Doggie Daycare Application

Woofgang s Doggie Daycare Application Woofgang s Doggie Daycare Application OWNER INFORMATION: Name Address City Zip Cell/Primary Phone Secondary Phone Email EMERGENCY CONTACT: Name Primary Phone DOG INFORMATION: Name Female Male Age Birthdate

More information

South Paw Doggie Daycare & Training Center

South Paw Doggie Daycare & Training Center South Paw Doggie Daycare & Training Center 24210 Parker Rd * Porter, Tx 77365 * (281) 354 7768* www.puppyschool.com Daycare Application Package Thank you for your interest in our doggie daycare. South

More information

FRIENDLY FARMS PET RETREAT APPLICATION

FRIENDLY FARMS PET RETREAT APPLICATION APPLICATION OWNER INFORMATION Name: Address: Telephone: Home Work Cell Email Address: If we are unable to reach you, whom can we call? Please provide name and telephone number. Please provide your veterinarian

More information

Pet Personality Profile

Pet Personality Profile Pet Personality Profile Owner s Information Last Name: First Name: Phone: (cell) (home) (work) Email: Emergency Contact Name: Phone: Pet s Information Name: Breed: Color: Sex: M F Spayed/neutered? Yes

More information

Daycare & Boarding Application

Daycare & Boarding Application Owner/Guardian Information Daycare & Boarding Application Name: Date Address: City/State/Zip: E-mail Address: Home # Work # Cell # Place of Employment: Emergency Contact: (Required-not in the same residence)

More information

Phone: Fax: Page 1

Phone: Fax: Page 1 Client Information Owner Name Address City State ZIP Home Phone Work Cell E-mail Address Occupation Employer Emergency Contact Name Home Phone Work Cell Pickup Authorization Name(s) Veterinary Information

More information

Client Information. Owner Name. Address. City State ZIP. Home Phone Work Cell

Client Information. Owner Name. Address. City State ZIP. Home Phone Work Cell 678-293-5933 www.puppytraining1on1.com @puppytraining1on1 Client Information Owner Name City State ZIP Home Phone Work Cell E-mail Occupation Employer Emergency Contact Name Home Phone Work Cell Pickup

More information

Daycare & Boarding Application

Daycare & Boarding Application New Daycare/Boarding Applicant Additional Family Member Existing Member s Updated Information Daycare & Boarding Application Guardian s/owner s Name: Address: City: State: Zip: Home Phone: ( ) Work Phone:

More information

DAYCARE INFORMATION FORM

DAYCARE INFORMATION FORM DAYCARE INFORMATION FORM BANDILANE CANINE CENTER Joyce Diamond, CPDT 80 Largo Drive, Stamford, CT 06907 ph: 203-975-8151, fx: 203-975-7457 email: info@bandilane.com www.bandilane.com OWNER S NAME ADDRESS

More information

Daycare, Boarding, Grooming, Training 6976 West 152 nd Terrace Overland Park, KS 66224

Daycare, Boarding, Grooming, Training 6976 West 152 nd Terrace Overland Park, KS 66224 Daycare, Boarding, Grooming, Training 6976 West 152 nd Terrace Overland Park, KS 66224 Phone: 913-685-9246 (WAGN) Fax 913-685-1922 Email: info@tailsrwaggin.com Website: www.tailsrwaggin.com CLIENT PROFILE

More information

Day Care and Boarding General Information and Policies

Day Care and Boarding General Information and Policies Day Care and Boarding General Information and Policies Charlotte Dog Resort provides a safe, fun, and stimulating social environment for dogs. To ensure the safety and health of your dog(s), we require

More information

TOP DOG DAYCARE ADMISSION PACKET. Client Name Home Mobile Work. Client Name Home Mobile Work. Address.

TOP DOG DAYCARE ADMISSION PACKET. Client Name Home Mobile Work. Client Name Home Mobile Work. Address. Start Date TOP DOG DAYCARE ADMISSION PACKET Client Name Home Mobile Work Client Name Home Mobile Work Address E-Mail Emergency Contact (Not listed above) Home Mobile Work Vet Clinic Dog s Name Breed Birthday

More information

New Client Information

New Client Information New Client Information Date: Primary Contact (Owner) Information Required Owner Name: Address: Apt. #: Home Phone: Work Phone: Cell Phone: Email: How did you hear about us? Emergency Contact Required Owner

More information

Owner s Name. Address. Primary Phone Alternate Phone. . Security Word (used for pick up verification) Other person authorized to pick up dog

Owner s Name. Address. Primary Phone Alternate Phone.  . Security Word (used for pick up verification) Other person authorized to pick up dog Paws n Claws Playcare 1530 W 26 th St. Erie PA 16508 814-456-7297 fax 814-456-7299 Playcare Pet Profile Owner s Name Address City St Zip Code Primary Phone Alternate Phone Email Security Word (used for

More information

7254 South Washington Street Grand Forks, ND (701) (701) Fax E- mail:

7254 South Washington Street Grand Forks, ND (701) (701) Fax   E- mail: DAYCARE & BOARDING OWNER INFORMATION OWNER #1 ADDRESS HOME PHONE WORK PHONE CELL PHONE E- MAIL OWNER #2 ADDRESS (IF DIFFERENT THAN ABOVE) HOME PHONE WORK PHONE CELL PHONE E- MAIL EMERGENCY CONTACT (OTHER

More information

Boarding/Daycare Contract

Boarding/Daycare Contract Boarding/Daycare Contract 1394 230th Street Glenwood City, Wisconsin 54013 715-265-9288 purrfectdog@live.com www.purrfectdog.com All boarding and daycare clients must sign a boarding/daycare contract for

More information

DOGTOPIA DOG ENROLLMENT FORM

DOGTOPIA DOG ENROLLMENT FORM DOGTOPIA DOG ENROLLMENT FORM We are thrilled your dog will be joining the fun here at Dogtopia! Please fill out the forms below, save and email to your preferred location. You can find each Dogtopia location's

More information

DOGTOPIA DOG ENROLLMENT FORM

DOGTOPIA DOG ENROLLMENT FORM DOGTOPIA DOG ENROLLMENT FORM We are thrilled your dog will be joining the fun here at Dogtopia! Please fill out the forms below, save and email to your preferred location. You can find each Dogtopia location's

More information

6 Bourbon St. D Peabody, MA CONTACT INFORMATION

6 Bourbon St. D Peabody, MA CONTACT INFORMATION 6 Bourbon St. D 978-854-5812 Peabody, MA 01960 luckydogsdaycare@gmail.com Pet's Name (s) Owner's Name (s) CONTACT INFORMATION Application Address City/State Zip Phone#1 Phone#3 Phone#2 Email Address VETERINARIAN

More information

AGREEMENT & WAIVER FORM

AGREEMENT & WAIVER FORM AGREEMENT & WAIVER FORM By signing this document I, as the owner/agent/guardian, guarantee that I will be personally liable for all expenses resulting from daycare, boarding, bathing and grooming, veterinarian

More information

Pawington, LLC Boarding and Services Agreement

Pawington, LLC Boarding and Services Agreement Pawington, LLC Boarding and Services Agreement Page 1 of 5 NOTICE TO THE PET OWNER/GUARDIAN: PLEASE READ CAREFULLY. THIS AGREEMENT INCLUDES A RELEASE OF LIABILITY AND WAIVER OF LEGAL RIGHTS AND DEPRIVES

More information

4 PAWS Community Center Dog Boarding and Daycare

4 PAWS Community Center Dog Boarding and Daycare 4 PAWS Community Center Dog Boarding and Daycare New Dog Interview Application Additional Family Member 2244 Franklin Rd. Bloomfield Hills, MI 48302 Update Existing Information (248) 230 PAWS OWNER INFORMATION:

More information

DAYCARE / BOARDING APPLICATION

DAYCARE / BOARDING APPLICATION Date: DAYCARE / BOARDING APPLICATION OWNER INFORMATION Address: City: Zip Code: Home phone: Cell: Work: E-mail Address: EMERGENCY CONTACT INFORMATION (someone t traveling with you) Relation: Home phone:

More information

New Member Registration Form

New Member Registration Form New Member Registration Form Application Process: A completed New Member Application packet must be submitted to PetCoral via email, mail or in person. Applications and vaccine records take 24 hours to

More information

Owner Liability Waiver and Health Certification

Owner Liability Waiver and Health Certification Owner Liability Waiver and Health Certification I,, hereby certify that my dog(s): is/are in good health and has/have not been ill with any communicable condition in the last 15 days. I further certify

More information

Puppy Play School CONTRACT

Puppy Play School CONTRACT Puppy Play School CONTRACT This Contract is between the Monadnock Humane Society ( MHS ) Boarding and Daycare facility (hereinafter called the Kennel ) and the pet owner (hereinafter called the Owner ).

More information

AGREEMENT & WAIVER FORM

AGREEMENT & WAIVER FORM AGREEMENT & WAIVER FORM By signing this document I, as the owner/agent/guardian, guarantee that I will be personally liable for all expenses resulting from daycare, boarding, bathing and grooming, veterinarian

More information

PAW PRINTS PET RESORT GUEST APPLICATION FORM

PAW PRINTS PET RESORT GUEST APPLICATION FORM Telephone: 250-597-DOGS Email: pawprintspetresort@gmail.com Web: www.pawprintspetresort.com PAW PRINTS PET RESORT GUEST APPLICATION FORM Date: Assessed by: Dog Information Dog s Name: Nicknames: Breed:

More information

Happy Hounds Doggie Day Care, LLC

Happy Hounds Doggie Day Care, LLC Owner Information: Address: Happy Hounds Doggie Day Care, LLC Client Info Sheet Phone: Cell: Email: Additional Owner Information: Address: Phone: Cell: Email: Dog Info: Age: Breed: Sex: Weight: Additional

More information

Lucky Dog Pet Lodge 1067 American Blvd East Bloomington, MN Phone: (952) Fax: (952) Site:

Lucky Dog Pet Lodge 1067 American Blvd East Bloomington, MN Phone: (952) Fax: (952) Site: Lucky Dog Pet Lodge 1067 American Blvd East Bloomington, MN 55420 Phone: (952) 767-2040 Fax: (952) 767-2041 Site: www.luckydogpetlodge.com Enrollment Application Please complete the following questions

More information

Owner s Name. Address. City State Zip Code. Home Phone Work Phone Cell Phone. Address Occupation. Employer. Emergency Contact s Name

Owner s Name. Address. City State Zip Code. Home Phone Work Phone Cell Phone.  Address Occupation. Employer. Emergency Contact s Name 712 Fairview Street Houston, Texas 77006 (713) 521-7877 fax: (713) 521-7879 www.daisysdoghouse.com CLIENT INFORMATION Owner s Name Address City State Zip Code Home Phone Work Phone Cell Phone Email Address

More information

Camp K-9 Pet Resort General Information and Policies. Boarding Grooming Day camp Training. Please keep this sheet for your records

Camp K-9 Pet Resort General Information and Policies. Boarding Grooming Day camp Training. Please keep this sheet for your records Camp K-9 Pet Resort General Information and Policies Boarding Grooming Day camp Training Please keep this sheet for your records Thank you for choosing Camp K-9 Pet Resort. The purpose of Camp K-9 is to

More information

APPLICATION & ENROLLMENT

APPLICATION & ENROLLMENT APPLICATION & ENROLLMENT OWNER S INFORMATION: Name: Address: City: State: Zip Code: Place of Employment: Home Phone: Work Phone: Cell Phone: E-mail Address: Emergency Contact Name (other than self): Relationship:

More information

Daycare / Boarding Application

Daycare / Boarding Application Daycare / Boarding Application Owner Information Name: Address: City: Zip: Home Phone: Cell: Email: Pet Information Name: Breed: Current Age: Weight: Birthday: Sex (check box): Male Female Spayed/Neutered?

More information

DOG ENROLLMENT FORM PET PARENT INFORMATION

DOG ENROLLMENT FORM PET PARENT INFORMATION DOG ENROLLMENT FORM Please complete the following questions to the best of your knowledge. This form and the subsequent evaluation are required before your dog can stay with us. This information will help

More information

Pet Personality Profile

Pet Personality Profile Please complete a profile for each dog to be enrolled in day camp at The Paws Resort & Spa. Complete responses assist us in the interview process. There are no right or wrong answers as all dogs are unique.

More information

SERVICE CONTRACT. THIS AGREEMENT is entered into by and between WAGS & WIGGLES DOG DAYCARE, PART DEUX, LLC (the Wags & Wiggles ) and ( Owner ):

SERVICE CONTRACT. THIS AGREEMENT is entered into by and between WAGS & WIGGLES DOG DAYCARE, PART DEUX, LLC (the Wags & Wiggles ) and ( Owner ): SERVICE CONTRACT THIS AGREEMENT is entered into by and between WAGS & WIGGLES DOG DAYCARE, PART DEUX, LLC (the Wags & Wiggles ) and ( Owner ): 1. Owner understands and agrees that Owner is solely responsible

More information

WVMC DAYCARE APPLICATION

WVMC DAYCARE APPLICATION WVMC DAYCARE APPLICATION WELCOME to WVMC S STAY and PLAY facility. We are delighted you have chosen us for your pets recreational and fun filled needs. The following informational packet is essential to

More information

Metro Dog Day Care and Boarding Program Application

Metro Dog Day Care and Boarding Program Application Metro Dog Day Care and Boarding Program Application Thank you for your interest in our programs for your dog. No one knows your dog better than you, which is why we appreciate you taking the time to fill

More information

Paw Paw s Pets 3124 Broad Avenue Memphis, TN

Paw Paw s Pets 3124 Broad Avenue Memphis, TN Paw Paw s Pets 3124 Broad Avenue Memphis, TN 38112 901-286-5488 New Member Application Parent / Pet Owner Information Name(s): Address: City: State: Zip: Home Phone: Cell: Email: How did you hear about

More information

Pooch Personality Profile

Pooch Personality Profile Pooch Personality Profile Complete a profile for each dog enrolled at Urban Tails. Complete responses assist us in providing high quality care for your dog. There are no right or wrong answers as all dogs

More information

Requirements and Reservations

Requirements and Reservations Requirements and Reservations Fuzzy Paws Pet Villa & Spa strives to provide a safe and positive experience for your dog(s). We have more than 20 years of pet care experience, and we pride ourselves in

More information

Please read and answer ALL questions. You can use a? or NA when applicable. Guardian/Human's Name: Mailing Address: City/Town State Zip

Please read and answer ALL questions. You can use a? or NA when applicable. Guardian/Human's Name: Mailing Address: City/Town State Zip New Doggy Dude Existing Dude's Updated Information Additional Doggy Dude Please read and answer ALL questions. You can use a? or NA when applicable. Guardian/Human's Name: Mailing Address: City/Town State

More information

Yes No PATIENT INFORMATION. Dogs: Cats: Feline Rabies: FVRCP (Feline Rhinotraceitis/Calicivirus/Panleukopenia):

Yes No PATIENT INFORMATION. Dogs: Cats: Feline Rabies: FVRCP (Feline Rhinotraceitis/Calicivirus/Panleukopenia): NEW PATIENT & CLIENT INFORMATION SHEET CLIENT INFORMATION First name Last name Spouse/Partner first name Spouse/Partner last name Address City State Zip Primary Phone # (home work cell) CIRCLE ONE *Please

More information

2 nd Pet Enrollment Application

2 nd Pet Enrollment Application 2 nd Pet Enrollment Application GENERAL INFORMATION Human Name: Spouse name: Email: Home phone: Cell: CANINE INFORMATION Name: Breed: Weight: Birth date: Male/Female: Neutered/Spayed: Color: Markings:

More information

Daycare/Overnight Boarding Master Record Enables us to provide the most comfortable & safe experience for your pet.

Daycare/Overnight Boarding Master Record Enables us to provide the most comfortable & safe experience for your pet. Daycare/Overnight Boarding Master Record Enables us to provide the most comfortable & safe experience for your pet. Rules and Regulations Trial Day/Date Monday Thursday (must be in at 7:00am) Health: All

More information

GUEST INFORMATION SHEET. How did you hear about Dogstown University? Relationship: Pet Name: Breed: Color/Markings: Approximate Weight:

GUEST INFORMATION SHEET. How did you hear about Dogstown University? Relationship: Pet Name: Breed: Color/Markings: Approximate Weight: DOGSTOWN UNIVERSITY 1807 South Powerline RD, Suite B-109, Deerfield Beach FL 33442 (954)-422-5764 FAX: (954)-794-0299 E-MAIL: dogstownuniversity@yahoo.com www.dogstownuniversityinc.com GUEST INFORMATION

More information

Compassionate Dog Training & Daycare. Daycare

Compassionate Dog Training & Daycare. Daycare Compassionate Dog Training & Daycare 63027 NE Lower Meadow Dr., Suite D Bend, OR 97701 Phone/Fax 541-312-3766 Daycare Welcome! Thank you for your interest in Dancin Woofs Dog Daycare. Our mission is to

More information

CAMPER PROFILE FORM CLIENT PROFILE. State Zip. Home Work Cell. Name Phone Relationship. Name Phone Relationship. Others authorized to pick-up my pet

CAMPER PROFILE FORM CLIENT PROFILE. State Zip. Home Work Cell. Name Phone Relationship. Name Phone Relationship. Others authorized to pick-up my pet CAMPER PROFILE FORM SNUGGLES AND HUGS 26781 HANNA RD. OAK RIDGE, TX 77386 936-443-3215 WWW.ACTIVEDOGCAMP.COM Please take a few minutes to complete this Application for your pet, one per pet please. It

More information

Day Care/Day Training Intake Forms

Day Care/Day Training Intake Forms Owner Information Day Care/Day Training Intake Forms Name: Address: E-Mail: Cell Phone: Work Phone: Home Phone: Veterinarian Information Clinic Name: Veterinarian s Name: Phone: Street Address: Emergency

More information

NEW MEMBER APPLICATION

NEW MEMBER APPLICATION NEW MEMBER APPLICATION WEST NASHVILLE 5001 ALABAMA AVE. NASHVILLE, TN 37209 PHONE 615.334.0000 FAX 615.790.0475 TDSWEST@thedogspot.com www.thedogspot.com PARENT INFO Name(s): Address: City: State: Zip:

More information

Peace of Mind Pet Sitting s Doggy Day Care & Pet Services NEW CLIENT INFORMATION PET PARENT INFORMATION DOG S INFORMATION

Peace of Mind Pet Sitting s Doggy Day Care & Pet Services NEW CLIENT INFORMATION PET PARENT INFORMATION DOG S INFORMATION Peace of Mind Pet Sitting s Doggy Day Care & Pet Services NEW CLIENT INFORMATION PET PARENT INFORMATION First Name Last Name Best Phone Number E-mail Date Your Dog s Veterinarian Clinic Preferred Doctor

More information

Registration Form. Community Event* Yelp. Advertisement* Walk/Drive-by. Other* Instagram. Rescue/Shelter*

Registration Form. Community Event* Yelp. Advertisement* Walk/Drive-by. Other* Instagram. Rescue/Shelter* Registration Form Owner s Name Address Home Phone # ( ) Work Phone # ( ) Cell Phone # ( ) Email Address Emergency Contact Information: (Authorized to pick-up/make decisions for dog) Name Phone # ( ) Relationship

More information

Daycare & Boarding Application

Daycare & Boarding Application Owner/Guardian Information Daycare & Boarding Application Name: Date Address: City/State/Zip: E-mail Address: Home # Work # Cell # Place of Employment: Emergency Contact: (Required-not in the same residence)

More information

Client Contract Form

Client Contract Form Last Name: 1691 Highway 357 Lyman SC, 29365 Phone: (864)655-5884 Fax: (864)655-5812 Support@theultimatepetlodge.com Client Contract Form Owner Information First Name: Address: City: State: Zip Code: Home

More information

310 Carver Lane, East Peoria, IL Phone: (309) Fax: (309)

310 Carver Lane, East Peoria, IL Phone: (309) Fax: (309) Owner Information Owner #1 Owner #2 Name Employer Home Phone Work Phone Cell Phone Email Address Physical Residence Address (Same for both Owners) Street/City/State/Zip Mailing Address (if different) Who

More information

Client Enrollment Form Completed, signed and sent to us prior to first day of class.

Client Enrollment Form Completed, signed and sent to us prior to first day of class. Thank you for your interest in Wag Club! We can t wait to meet your pup! Below is a checklist of pre-requisites to help you complete enrollment for Training Classes, the Wine N Puppies playgroup and Special

More information

Client Enrollment Form Completed, signed and sent to us prior to your first day of class.

Client Enrollment Form Completed, signed and sent to us prior to your first day of class. Thank you for your interest in Wag Club! We can t wait to meet your pup! Below is a checklist of pre-requisites to help you complete enrollment for Training Classes, the Puppies N Wine playgroup and Special

More information

*Please Complete This Form* Owners Name: Address City : State : Zip : Home Phone : Business Phone : Cell Phone :

*Please Complete This Form* Owners Name: Address City : State : Zip : Home Phone : Business Phone : Cell Phone : ! Page 1 *Please Complete This Form* Owners Name: Address City : State : Zip : Home Phone : Business Phone : Cell Phone : Email : Dog s Information: Name of Dog(s) : Breed(s) : Weight : Color : Birth Date

More information

PAWSITIVELY PERFECT BOARDING & DAYCARE AGREEMENT. Address: City: State: Zip: Phone: Home: Work: Cell: Text? Y N

PAWSITIVELY PERFECT BOARDING & DAYCARE AGREEMENT. Address: City: State: Zip: Phone: Home: Work: Cell: Text? Y N PAWSITIVELY PERFECT BOARDING & DAYCARE AGREEMENT Contact Information: Owner s Name(s): Address: City: State: Zip: Phone: Home: Work: Cell: Text? Y N Email: Do you check your email while gone? Y N Emergency

More information

Terms and Conditions (from February 2016)

Terms and Conditions (from February 2016) Terms and Conditions (from February 2016) General to all Four Paws Services 1. By attending doggie daycare, kennels or using any of Four Paws Pet Services you agree to all terms and conditions detailed

More information

Dog Owner s Name. City State Zip. Cell Phone Home Phone. . Emergency Contact Number. Dog s Name Breed. Dog s Birthday.

Dog Owner s Name. City State Zip. Cell Phone Home Phone.  . Emergency Contact Number. Dog s Name Breed. Dog s Birthday. HOUND HAUS L.L.C. Boarding Obedience Training Daycare Dog Owner s Name Address: City State Zip Cell Phone Home Phone Email Emergency Contact Number Dog s Name Breed Male Female Spayed/Neutered Dog s Birthday

More information

2203 Durham Dr Houston, TX t f e.

2203 Durham Dr Houston, TX t f e. 2203 Durham Dr Houston, TX 77007 t. 713.426.5700 f. 281.501.2767 e. info@yuppiedogdaycare.com New Client Package Thank you for choosing Yuppie Dog for the care of your dog(s)! Please complete and fax the

More information

Member Benefits: One Year Membership: $40.00 Dog Wild Access Pass for unlimited access to the dog park during general-use hours.

Member Benefits: One Year Membership: $40.00 Dog Wild Access Pass for unlimited access to the dog park during general-use hours. Dog Wild Club Membership The primary benefit of becoming a member of the Dog Wild Club is access to the private, members-only Dog Wild Park. Memberships are valid for one year (12 months) and must be paid

More information

Dog Enrollment Application

Dog Enrollment Application Dog Enrollment Application Page 1 of 5 OWNER INFO: NAME: ADDRESS: CITY/STATE/ZIP CELL PHONE: WORK PHONE: HOME PHONE: OTHER PHONE: EMAIL: EMPLOYER: DRIVERS LICENSE #: STATE ISSUED EMERGENCY CONTACT INFORMATION

More information

Playcare, Boarding, & Dog Walking Application

Playcare, Boarding, & Dog Walking Application Playcare, Boarding, & Dog Walking Application Dog Owner Information Name Address City State Zip Work phone Home phone Cell Phone Email address How did you hear about us? Emergency Contact Information Name

More information

Off-Leash Play Application

Off-Leash Play Application Off-Leash Play Application We love dogs and want your dog to love coming to our off-leash playgroup. No one knows your dog better than you, so we d appreciate you taking the time to fill out this application.

More information

Canine Enrollment Form

Canine Enrollment Form TODAY S DATE: *PLEASE PRINT CLEARLY IN INK* Full name and address (including zip) of owner / person/s responsible for payment: Driver s License Number: State license is issued in: Home Phone ( ) Work Phone

More information

The Dog Wash & Grooming, INC National Road St. Clairsville, OH Phone: Web: Thedogwashandgrooming.com

The Dog Wash & Grooming, INC National Road St. Clairsville, OH Phone: Web: Thedogwashandgrooming.com The Dog Wash & Grooming, INC. 46147 National Road St. Clairsville, OH 43950 Phone: 740.296.5495 Web: Thedogwashandgrooming.com Owner Name: Street Address: City: State: Zip: Email: Phone: Cell: Emergency

More information

The Scruffy Puppy Hazlet, NJ scruffypuppypetcare.com

The Scruffy Puppy Hazlet, NJ scruffypuppypetcare.com The Scruffy Puppy Hazlet, NJ 732-520-0454 scruffypuppypetcare.com In Home Dog Boarding Application & Agreement *Please PRINT clearly in blue or black ink & Fill in all applicable fields to the best of

More information

Boarding & Daycare Contract

Boarding & Daycare Contract Boarding & Daycare Contract This is a contract between Ruff House Kennel and Daycare, LLC and the Pet Owner, or his agent. All pets are boarded, or otherwise handled or cared for, by Kennel staff without

More information

Aunt Lyn s Doggie Care

Aunt Lyn s Doggie Care Fee Schedule Services: All services must be prepaid. Monthly Passes must be used in the month of purchase. Members lock in the same price for vacation and extra days PREPAID MONTHLY DAYCARE MEMBERSHIPS

More information

GUEST INFORMATION SHEET

GUEST INFORMATION SHEET DOGSTOWN UNIVERSITY GUEST INFORMATION SHEET Please complete this form and bring it with you at check-in. Owner s Name: Preferred Accommodations: Small Mini Large Mini Large X-Large Super Suite Lounge Playroom

More information

Client Information. Dog Profile

Client Information. Dog Profile Every Client is required to read and sign this form prior to any service rendered at 20 th Street Grooming & Doggie Daycare. Thank you and we would like to Welcome you and your dog(s) to 20 th Street Grooming

More information

OWNER SURRENDER FORM

OWNER SURRENDER FORM P.O. Box 110987 Naples Florida 34108 Phone/Fax: 239-369-0415 info@grrswf.org www.grrswf.org OWNER SURRENDER FORM We understand that giving up your pet is a difficult decision, but we realize that in making

More information

Bellyrubs Doggie Daycare & Boarding LLC 1089 State Rte. 9 Gansevoort, NY (518)

Bellyrubs Doggie Daycare & Boarding LLC 1089 State Rte. 9 Gansevoort, NY (518) Bellyrubs Doggie Daycare & Boarding LLC 1089 State Rte. 9 Gansevoort, NY 12831 (518)747-6815 www.bellyrubsdoggydaycare.com ABOUT US Bellyrubs is family owned and operated. We pride ourselves in our safe,

More information

C o m p l e t e C a n i n e C a r e E n r o l m e n t F o r m P a g e 1 5. OWNER INFORMATION Forename & Surname. Home Phone Work Phone Mobile Phone

C o m p l e t e C a n i n e C a r e E n r o l m e n t F o r m P a g e 1 5. OWNER INFORMATION Forename & Surname. Home Phone Work Phone Mobile Phone OWNER INFORMATION Title Forename & Surname Home address Work address Home Phone Work Phone Mobile Phone Email PARTNER/SPOUSE Name Work Phone Mobile Phone How did you hear about us? Word of mouth Email

More information

Cat Boarding Enrollment Packet

Cat Boarding Enrollment Packet Cat Boarding Enrollment Packet For Office Use Only Vaccines Checked In Computer Init.. Vaccination Records MUST accompany this form. Owner Information Name(s): Street Address: City: St: Zip: Home Phone:

More information

Daycare Application. Additional Owner s Name(s) authorized to drop off and pick up your dog

Daycare Application. Additional Owner s Name(s) authorized to drop off and pick up your dog Fax (503) 990-6782 Daycare Application Dog s Name Date of Birth M F Breed _ Spayed/Neutered? Y N When? Weight Is your dog on a flea program? Y N If yes, product used Is your dog on a heartworm program?

More information