DAYCARE / BOARDING APPLICATION

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1 Date: DAYCARE / BOARDING APPLICATION OWNER INFORMATION Address: City: Zip Code: Home phone: Cell: Work: Address: EMERGENCY CONTACT INFORMATION (someone t traveling with you) Relation: Home phone: Cell: Work: Who besides yourself is authorized to pick up your dog(s)? DOG INFORMATION MALE FEMALE Breed: Weight: Age: Colors/Markings: Birth Date: YES, my dog is spayed neutered NO, my dog is NOT spayed/neutered (required at 7 months) VACCINATION INFO Owner must provide proof of current / updated Rabies, Distemper/Parvo (DHPPV) and bordetella in accordance with our vaccination requirements - we also recommend your dog get the Canine Influenza vaccine Veterinarian: MEDICAL INFORMATION City: Does your dog take any medications? NO YES - if, please list below Will we be Medication: Directions: administering? When do you rmally feed your dog? Morning Afteron Evening 1 of 5

2 How did you hear about Desert Dog Daycare: ADDITIONAL INFORMATION If referred, name of person that referred you: (they get a free day!) Has your dog ever been in daycare before: NO YES If so, where: What is your primary reason for bringing your dog to Desert Dog: Boarding Daycare ADDITIONAL BEHAVIORAL INFORMATION Where did you get your dog? How long have you owned your dog? Does your dog get along with other resident animals, if you have any? NO YES if, explain: Has your dog successfully shared food, water or toys with other animals? NO YES if, explain: Is there any person, dog, or situation that makes your dog uncomfortable? NO YES Can you take food, treats, toys away from your dog without him growling or showing teeth? NO YES Has your dog ever growled at or bitten ather person or dog? NO YES Does your dog have any allergies, special needs, injuries or disabilities (past or present)? NO YES Does your dog have any areas where they do t like to be touched by humans? NO YES Has your dog ever climbed / jumped a fence? NO YES - height? Has your dog ever socialized off-leash with large groups of dogs (15+)? NO YES if, where: Are there any restrictions on your dogs activities? NO YES I, the undersigned, hereby ackwledge and agree that all of the information contained in this application is true and accurate to the best of my kwledge. I further attest, that if I am t the sole owner or the dog for which this application has been completed, my signature is sufficient to enter into this agreement for and on behalf of any other owner or representative. Owner / Guardian Signature Date DESERT DOG POLICIES, PROCEDURES AND RELEASE/WAIVER AGREEMENT Read carefully: this agreement includes a Release of Liability and Waiver of legal rights and deprives you of the right to sue Desert Dog Daycare and related parties. 1. I understand that I am responsible for any harm caused by my dog while my dog is attending daycare at Desert Dog Daycare LLC. I shall indemnify Desert Dog Daycare LLC against any claims made against the corporation or losses or damages of any kind suffered by Desert Dog Daycare LLC as a result of my failure to inform Desert Dog Daycare LLC of any pre-existing condition my dog may have (such as illness or aggression problems.) I understand and agree that in admitting my dog to Desert Dog Daycare, the facility has relied on my representation that my dog is in good health and has t harmed or shown aggressive or threatening behavior towards any person or any other dog. (continued on page 3) 2 of 5

3 2. I understand and agree that Desert Dog Daycare LLC will t be liable for problems, damage, or injury caused by my dog provided reasonable care and precautions are followed by day care staff. I understand that Desert Dog Daycare LLC is fully insured. I release Desert Dog Daycare LLC of any liability arising from my dog s attendance and participation at the daycare. I understand that the day care is a place where dogs co-mingle in groups. I understand my dog may be placed in a kennel for "time outs" t to exceed twenty minutes if their behavior is unacceptable or if they become overexcited, for overnight care or if injured. I understand that when dogs play in group s injuries may occur. Daycare staff may or may t tify me immediately. If the injury is t serious the staff can let my dog continue to play and let me kw about it when I pick up. If the injury is serious I will be tified immediately. In the case of such injury, Desert Dog will determine liable party or parties depending on the nature of incident. 3. I understand and agree that any problem or injury that develops with my dog will be treated as deemed best by Desert Dog Daycare. Either my veterinarian or a Desert Dog recognized veterinarian will be contacted in the event of a medical problem that is serious in nature. I agree that I am fully responsible for the costs of any such medical treatment. I, as the owner, agree to be solely responsible for any and all acts or behavior of my dog while in the care of Desert Dog Daycare LLC. If my dog should become ill or seem to be in need of medical consideration, Desert Dog Daycare LLC reserves the right to administer aid and/or to use any available veterinarian. I, the owner, shall pay any expenses so incurred. 4. I recognize that there are inherent and potential risks involved with human/dog interaction as well as dog/dog interaction. These risks include but are t limited to illnesses (i.e. kennel cough, canine influenza, upper respiratory infections, etc.), damage to personal property, bodily injury, etc. I fully accept and assume all risks/responsibilities associated with bringing my dog to Desert Dog, including but t limited to any veterinary expenses incurred on behalf of my dog or for injuries inflicted on other dogs or humans by my dog. 5.I understand that if my dog is left at the day care for three days without reservations or contact from the owner this dog will be considered abandoned and necessary steps will be taken to turn the dog over to the proper authorities. 6. I agree that Desert Dog is t liable for damage to personal property belonging to myself or my dog. I understand that items brought for overnight stays may be damaged/destroyed. 7. My dog is t aggressive, however if he/she behaves aggressively or displays behaviors deemed unacceptable by Desert Dog, he/she will be removed from the play group. If Desert Dog deems my dog a danger to himself/herself or others, my dog may be asked t to return. Such determinations will be made at the sole discretion of Desert Dog Daycare. 8. My dog(s) will enter and exit Desert Dog on a leash. Loaner leashes are available at the front door of the lobby and may be used to safely lead your dog to and from your vehicle, then returned to the lobby once your dog is safely in your car, they will t be taken home. Repeated entry without a leash is grounds for dismissal. This is in effect to protect all dogs and humans on the premises. 9. I understand that Desert Dog loves to take pictures of the dogs during play time. I consent for such pictures to be used on the website, facebook, digital frame in the lobby, etc. as well as for marketing material. 10. I understand that Desert Dog removes the collars of all dogs entering the play area for their safety during play. I agree to have a tag on my dogs collar with their name clearly written so that my dogs collar can be easily identified and put back on upon pick up. Jiffy-tags may be available to purchase from Desert Dog - if after 3(three) days of daycare I have t provided a tag, Desert Dog may create one for my dog and bill purchase to my account. 11. I understand that if I do t bring my dog to Desert Dog for daycare or boarding for a period of 6 months or more, my dog will have to re-interview and I will be responsible for paying for a day of daycare. 12. I agree that this release shall be binding on me and my successors, heirs, assigns & legal representatives. I have fully read and understand the terms of the above DESERT DOG POLICIES, PROCEDURES AND RELEASE/WAIVER AGREEMENT and understand that I have given up substantial rights by signing it and have done so voluntarily. Owner / Guardian Signature Date 3 of 5

4 4 of 5

5 This copy is for your records, you may remove it from the rest of the application and keep DESERT DOG POLICIES, PROCEDURES AND RELEASE/WAIVER AGREEMENT Read carefully: this agreement includes a Release of Liability and Waiver of legal rights and deprives you of the right to sue Desert Dog Daycare and related parties. 1. I understand that I am responsible for any harm caused by my dog while my dog is attending daycare at Desert Dog Daycare LLC. I shall indemnify Desert Dog Daycare LLC against any claims made against the corporation or losses or damages of any kind suffered by Desert Dog Daycare LLC as a result of my failure to inform Desert Dog Daycare LLC of any pre-existing condition my dog may have (such as illness or aggression problems.) I understand and agree that in admitting my dog to Desert Dog Daycare, the facility has relied on my representation that my dog is in good health and has t harmed or shown aggressive or threatening behavior towards any person or any other dog. 2. I understand and agree that Desert Dog Daycare LLC will t be liable for problems, damage, or injury caused by my dog provided reasonable care and precautions are followed by day care staff. I understand that Desert Dog Daycare LLC is fully insured. I release Desert Dog Daycare LLC of any liability arising from my dog s attendance and participation at the daycare. I understand that the day care is a place where dogs co-mingle in groups. I understand my dog may be placed in a kennel for "time outs" t to exceed twenty minutes if their behavior is unacceptable or if they become overexcited, for overnight care or if injured. I understand that when dogs play in group s injuries may occur. Daycare staff may or may t tify me immediately. If the injury is t serious the staff can let my dog continue to play and let me kw about it when I pick up. If the injury is serious I will be tified immediately. In the case of such injury, Desert Dog will determine liable party or parties depending on the nature of incident. 3. I understand and agree that any problem or injury that develops with my dog will be treated as deemed best by Desert Dog Daycare. Either my veterinarian or a Desert Dog recognized veterinarian will be contacted in the event of a medical problem that is serious in nature. I agree that I am fully responsible for the costs of any such medical treatment. I, as the owner, agree to be solely responsible for any and all acts or behavior of my dog while in the care of Desert Dog Daycare LLC. If my dog should become ill or seem to be in need of medical consideration, Desert Dog Daycare LLC reserves the right to administer aid and/or to use any available veterinarian. I, the owner, shall pay any expenses so incurred. 4. I recognize that there are inherent and potential risks involved with human/dog interaction as well as dog/dog interaction. These risks include but are t limited to illnesses (i.e. kennel cough, canine influenza, upper respiratory infections, etc.), damage to personal property, bodily injury, etc. I fully accept and assume all risks/responsibilities associated with bringing my dog to Desert Dog, including but t limited to any veterinary expenses incurred on behalf of my dog or for injuries inflicted on other dogs or humans by my dog. 5.I understand that if my dog is left at the day care for three days without reservations or contact from the owner this dog will be considered abandoned and necessary steps will be taken to turn the dog over to the proper authorities. 6. I agree that Desert Dog is t liable for damage to personal property belonging to myself or my dog. I understand that items brought for overnight stays may be damaged/destroyed. 7. My dog is t aggressive, however if he/she behaves aggressively or displays behaviors deemed unacceptable by Desert Dog, he/she will be removed from the play group. If Desert Dog deems my dog a danger to himself/herself or others, my dog may be asked t to return. Such determinations will be made at the sole discretion of Desert Dog Daycare. 8. My dog(s) will enter and exit Desert Dog on a leash. Loaner leashes are available at the front door of the lobby and may be used to safely lead your dog to and from your vehicle, then returned to the lobby once your dog is safely in your car, they will t be taken home. Repeated entry without a leash is grounds for dismissal. This is in effect to protect all dogs and humans on the premises. 9. I understand that Desert Dog loves to take pictures of the dogs during play time. I consent for such pictures to be used on the website, facebook, digital frame in the lobby, etc. as well as for marketing material. 10. I understand that Desert Dog removes the collars of all dogs entering the play area for their safety during play. I agree to have a tag on my dogs collar with their name clearly written so that my dogs collar can be easily identified and put back on upon pick up. Jiffy-tags may be available to purchase from Desert Dog - if after 3(three) days of daycare I have t provided a tag, Desert Dog may create one for my dog and bill purchase to my account. 11. I understand that if I do t bring my dog to Desert Dog for daycare or boarding for a period of 6 months or more, my dog will have to re-interview and I will be responsible for paying for a day of daycare. 12. I agree that this release shall be binding on me and my successors, heirs, assigns & legal representatives. 5 of 5

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