Day Care/Day Training Intake Forms

Transcription

1 Owner Information Day Care/Day Training Intake Forms Name: Address: Cell Phone: Work Phone: Home Phone: Veterinarian Information Clinic Name: Veterinarian s Name: Phone: Street Address: Emergency Contact Information This cannot be yourself; it must be someone else we can contact if we are unable to get ahold of you in an emergency situation. Name:

2 Cell Phone: Work Phone: Home Phone: Aside from the listed emergency contact, who else do you authorize to pick your dog up from Instinct s Daycare? Revised

3 Day Care/Day Training Intake Forms RELEASE FORM The undersigned person has registered to participate in Instinct Dog Training s Day Care/Day Training program in Fresno, California. 1. I hereby certify that I am the owner of, the dog that will participate in Day Care and/or Day Training. 2. I understand that other dogs will attend Day Care/Day Training and that during the course of participation, my dog may come into direct contact with all other participating dogs. 3. I hereby certify that the above named dog has been fully vaccinated for canine distemper, canine parvo virus, canine hepatitis, canine parainfluenza and canine corona virus (DHPPC), as well as bordetella (kennel cough), and rabies in accordance with local laws. I am aware that my dog may be exposed to those infection diseases described above. However, since Instinct Dog Training has advised me that my dog should be fully vaccinated against those diseases before attending Day Care/Day Training, I alone assume responsibility for any such exposure. Initials: 4. I understand if my dog has any of the following symptoms, I need to notify Day Care Staff prior to bringing your dog to daycare: diarrhea, vomiting, coughing and/or hacking, lethargy. These can be signs of a serious illness. If you bring your dog to us without disclosing that they are sick, you may be subject to a disinfecting fee and forfeiting your remaining package credit. Initials: 5. If you, the owner of the dog participating in Day Care/Day Training opt not to have your pet spayed or neutered, Instinct Dog Training will not be held responsible for any unplanned interaction/breeding. Intact pets tend to be territorial (marking) and/or aggressive. Instinct Dog Training will not tolerate any marking of territory and/or aggressive behavior. 6. I am aware that given the sometimes unpredictable nature of dogs, an interaction could take place between animals at Day Care/Day Training, which may result in injury to my dog, or other dogs, or to other people. I alone resume responsibility for any such injury and I am aware that if my pet becomes aggressive or destructive to another animal or property he or she will be placed in a timeout and/or our trainers will deal with the behavior accordingly. 7. As to Instinct Dog Training and its assistants, I hereby waive and release any actions, causes of actions, damages, rights, claims, or lawsuits which I may have for: (a) any and all personal injury or property damage which may be sustained arising out of any interaction between dogs

4 participating in Day Care/Day Training; and (b) any and all injury, illness or disease sustained by my dog arising our of or stemming from its participation in Day Care/Day Training. 8. I hereby assign and grant Instinct Professional Dog Training the right and permission to use, reproduce, distribute, and publish the photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) made of me and/or my dog (s) at any time during the Day Training and/or Day Care of my dog(s) by Instinct Professional Dog Training, and I hereby release Instinct Professional Dog Training including Brittany Sawyer-Guthrie, and her assistants from any and all liability resulting from such use, reproduction, distribution, and publication.i hereby authorize the reproduction, sale, distribution, copyright, exhibit, broadcast, and/or electronic storage of any and all such photograph(s), film(s), videotape(s), audio and video recording(s), electronic representation(s) and/or sound recording(s) without limitation at the discretion of Brittany Sawyer-Guthrie and I specifically waive any right to any compensation I may have for any of the foregoing. 9. I have read and understand this release form and I will honor and abide by the terms and conditions set forth above. 10.I give my pet permission to co-mingle/socialize with other Day Care/Day Training participants. Name of Owner or Legal Guardian (print) Signature Date: Revised

5 Scheduling Policy All scheduling for Day Care and Day Training will need to be ed to or you may leave a message at Ext. 3 Please note that Day Care is Extension 3. If messages are left on other lines, our Day Care staff is unable to get them, so you may be charged a No Show/Late Cancellation Fee if left on the incorrect line. Changes to your dog s Day Care or Day Training schedule must be made no later than Monday at 12pm for the week s schedule. Cancellation & No Show Policy Because we are a specialized Day Care, we have limited spots available based upon space and staffing, so reservations are required for Day Care & Day Training. If your dog will not be attending on a scheduled day, you must notify no later than 10 a.m. the day prior. Notice can be given by contacting our Day Care Staff via , daycare@fresnodogtraining.com, or phone, (559) Ext 3. If you do not notify the Day Care Staff of your cancellation before 10am the day prior, a No Show/Late Cancellation Fee will be charged. You will have an invoice ed to you that must be paid for your dog to return to Day Care or Day Training. The No Show/Late Cancellation fees will be as follows: Day Care No Show/Late Cancellation Fee: $15.00 Day Training No Show/Late Cancellation Fee: $30.00 Early Morning Drop Off & Late Pick Up Policies

6 Regular scheduled morning drop off hours are from 8 a.m. 10 a.m. & regular Pick Up hours are from 4 p.m. to 6 p.m. Earlier times are priced as follows: 7:30 a.m. Drop Off Courtesy No Charge must be scheduled with Day Care Staff 7 a.m. Drop Off or Earlier- $25.00 All dogs must be picked up by 6p.m. - Any dogs picked up after 6p.m. will be charged a $1 per minute late fee that must be paid upon arrival. Package Expiration Policy Day Care and Day Training Packages must be used within the time frames below: 20 Day Packages must be used within 3 months of purchase date 30 Day Packages must be used within 4 months of purchase date If a dog misses 3 consecutive weeks of Day Training or Day Care with no communication from owners, the package will expire 2 months from purchase date Any remaining credit will be forfeited if not used by the expiration date. Transportation Policy Transportation to the groomers is a $10 fee. Transportation home or to vet appointments within 10 miles of our facility are $25. Anything over 10 miles is an added charge of $0.60 per mile. I have read, understand, and accept all of the above Instinct Dog Training Policies and Fees. Name: Date: Revised

7 Day Care/Day Training Intake Forms Dog s Profile Your answers simply help us to get a better understanding of your dog s history, and which dogs they would be best suited for. You must fill out a separate profile for each dog you wish to enroll in daycare. Dog s Name: Breed: Date of Birth/Age: Male Female Spayed/Neutered Intact 1. Where did you get your dog? 2. When did you acquire your dog? 3. If adopted, what knowledge do you have of your dog s history? Interactions With Other Animals 1. Has your dog played with other dogs? Yes No If yes, how many dog friends does your dog have? 2. Describe your dogs play style.

8 3. How does your dog react to puppies? 4. What type of dog does your dog prefer to play with (breed, size, ect.)? 5. Does your dog prefer to play with Male or Female dogs? 6. How does your dog react to other dogs approaching the home or yard? 7. How does your dog react to other dogs in public ON leash? 8. How does your dog react to other dogs in public OFF leash? 9. Does your dog fear or dislike any types of dogs? 10. What happens when another dog tries to take food or toys from your dog?

9 11.Has your dog ever bitten another dog? Yes No If yes, what were the circumstances? 12. Has your dog ever been bitten by another dog? Yes No If yes, what were the circumstances? Interactions with People 1. How does your dog react to strangers? 2. Are there any types of people that your dog automatically dislikes or fears? Yes No If yes, please describe. 3. How does your dog behave around children? 4. What happens when a person tries to take a toy or food from your dog? 5. Has your dog ever bitten anybody? Yes No If yes, what were the circumstances?

10 General Information 1. Rate your dog s energy level 1 being very mellow and 10 being totally uncontrollable 2. Is your dog frightened by any noises or objects? Yes No If yes, please describe 3. Is your dog frightened by anything else? Yes No If yes, please describe 4. Is your dog mouthy or does he nibble on you? Please Explain. 5. Does your dog bark a lot? 6. Does your dog growl? Yes No Is it a play growl or a warning growl? 7. Where are your dog s favorite petting spots? Are there any spots they don t like? 8. What is your dog s training history? (Check all that apply) No Training Group Classes Basic Manners Puppy Kindergarten Private Training Lessons Trained Yourself Group Classes Advanced 9. What commands does your dog know? 10.Does your dog have a bathroom command? Yes No What is it? 11. Is your dog crate trained? Yes No

11 12. Do they have a preference of crate? (Ex. Some dogs are more anxious in a plastic vs. a wire crate) Wire Crate Plastic Crate Doesn t Matter Health Information 1. Does your dog take medication? Yes No If so, for what? How often? 2. Does your dog have any past injuries or conditions? If so, please describe 3. Does your dog have any sensitive areas on the body? If so, where? 4. Does your dog have any food, environmental, or drug allergies? 5. Can we give your dog treats while in daycare? 6. What type of food does your dog eat? Brand/Variety? Other Please list any other comments about your dog that you feel will be helpful.