Daycare Application Form

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Transcription:

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 Name Telephone Mobile Email Address Partner/Spouse Name Telephone Mobile Email Emergency contact (If urgent contact is required and you are not available) Name Telephone Mobile Email Address Page 2 of 6

Dog details Name Date of birth Breed Colour Sex Weight Neutered / Spayed? Neutered / Spayed age Is your dog child friendly? From where did you get your dog? If adopted, please give a brief description of your dog's history (if known) How many dogs in the household? Has your dog ever bitten anyone? Is your dog protective/territorial? Has your dog ever shown any signs of aggression? Has your dog ever been involved in any kind of incident? If you answered yes to any of the above, please provide more information. Does your dog socialise well with others? Please give details of any training given. Is your dog friendly towards other animals? (i.e. cats, other domestic animals, farm animals, wildlife) Page 3 of 6

Does your dog have any preexisting or current health conditions? If yes, please provide details Has your dog been ill in the last 30 days? Has your dog ever had a seizure? Does your dog have any allergies? Does your dog have hip dysplasia? Does your dog have any sensitive areas on his/her body? Does your dog have any physical limitations that need special attention or that may prevent certain types of play? Is your dog on any medication? If you answered yes to any of the above, please provide more information. Does your dog enjoy being brushed? Is your dog happy to have his / her nails clipped? Is your dog allowed treats whilst at daycare? Page 4 of 6

Vet Details Vet Practice Vet telephone number Vet address Vaccinations Please provide the date your dog last received vaccinations below. Vaccination standard (DHPP) Bordatella (Kennel Cough) Last flea treatment Flea and tick prevention method used *Please provide us with a copy of your dog s vaccination records The information I have given above is true, correct and complete to the best of my knowledge. I certify that I have read and understand the terms and conditions set forth.i agree to abide by the terms and conditions and accept all terms, conditions, and statements. I hereby release Cheshire LTD, their staff, and volunteers of any liability of any kind whatsoever arising from my dogs attendance and participation at Daycare. Signature Print name Date Page 5 of 6

Terms & Conditions I (the owner) confirm to Cheshire that I am legal owner of my dog. I understand that I am solely responsible for any and all harm caused by my dog while my dog is attending Daycare, or is using any services provided by Cheshire School of dogs LTD. I confirm that my dog has received all necessary vaccinations. I understand that Cheshire is an open day care centre I agree that my dog will socialise with other dogs and I accept the risks involved and agree that Cheshire School Of Dogs are not liable for any injuries or illnesses resulting during my dog s attendance. I have disclosed to Cheshire any known dangers associated with my dog. Any behaviour deemed dangerous or inappropriate by Cheshire may result in the instant dismissal of my dog(s). If any medical problems develop while my dog is in the care of Cheshire and I cannot be contacted, I authorise them to do whatever they deem necessary for the safety, health and wellbeing of my dog and I agree to assume full financial responsibility for all expenses incurred. I understand that I must give at least 24 hours notice of cancellation. I understand that the hours of operation are 7:30am - 6:00 pm and a 3 late fee charge applies for every 15 minutes thereafter. If I have not picked my dog up by 7:00pm, Cheshire will make arrangements for overnight boarding at my expense. If I purchase a half day service and fail to pick my dog up by 1pm, I will be charged the full day rate. 1. I further understand and agree in admitting my dog that School of dogs has relied on my representation that my dog is in good health and has not harmed or shown aggression or threatening behavior toward any person or any other dog. 2. I further agree to notify School of dogs of any unwelcome, aggressive, procreative, or dangerous behavior of my dog that has potential to cause harm to any other pet or individual. 3. I further understand that during normal dog play, owner s dog may sustain injuries. All dog play is carefully monitored at School of dogs to avoid injury, but scratches, punctures, torn ligaments, or other injuries that may occur despite the best supervision. I realize that pads on paws may initially become sensitive, or bothered until my dog becomes used to running on different surfaces. 4. I further understand that if I fail to provide proof of current vaccinations or if my dogs vaccinations are found to be expired or otherwise incomplete, School of dogs has the right to refuse service until current proof is provided. 5. I further understand and agree that any behavioral or health problems that develop with my dog will be treated as deemed best by the staff at, in their sole discretion, and that I will assume full financial responsibility for any and all expenses involved. I authorize School of dogs to obtain medical records and/or treatments for my dog in the event of injury or illness from my vet or from the closest veterinary clinic. By signing this document, I further direct said vet to provide such records upon request. 6. I further understand that my dog should be castrated (if male and over the age of 6 months) to enrol at School of dogs daycare. Bitches must not be brought when on heat. 7. I further understand that even if my dog is vaccinated for Bordatella (Kennel Cough) there is a chance that my dog can still contract Kennel Cough. I agree that I will not hold School of dogs responsible if my dog contracts Kennel Cough while attending Daycare. 8. I further agree to notify School of dogs of any infectious and/or contagious disease or conditions my dog has been exposed to or is affected by. Such diseases and conditions include, but are not limited to Distemper, Hepatitis, Kennel Cough (Bordatella), Parvovirus, Corona virus, worms, Lyme disease, Fleas, Pregnancy, Infectious Skin Diseases and Intestinal Parasites. 9. I further agree to take any necessary efforts or precautions to ensure that my dog is continuously free of contagious, infectious, or otherwise communicable diseases. I will report to Pretty Paws, before arriving at Daycare, any contagious, infectious or otherwise communicable diseases, and will not be allowed to bring my dog to School of dogs, regardless of scheduled days, until the condition is resolved. Resolution is determined by School of dogs. 10. I allow and consent my dog to being photographed, videotaped, and/or used in any media or advertising by School of dogs. All such photographs, etc. are the property of School of dogs. Page 6 of 6

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