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: Email: 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.
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
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.
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
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: