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 Phone: Business: Cell: Veterinarian Information Vet s Name: Company Name: Phone Number: Address: Dog Information Nick Names: Breed: Age: Sex: Male Female Spayed/Neutered? Yes No Vaccinations? Yes No 1
Health, Training and Temperament Questions How long have you had your dog? How old was your dog when you first obtained him/her? Where did you get your dog? Are there any other animals in your household? Please list: How does your dog get along with these animals? How much and how often do you feed your dog? What type of food do you feed your dog? How many elimination walks do you give your dog per day? Is your dog: (circle all that apply) Allowed to run free in the house: Allowed to run free in a fenced yard: Allowed outside with no fenced yard: Supervised/Unsupervised Supervised/Unsupervised Leash only/unleashed & Supervised/Unleashed & Unsupervised What is your dog s training history? (circle all that apply) No training Group classes basic Trained yourself Group classes intermediate Puppy classes Group classes advanced Private training How would you respond if your dog did something wrong in the home? Please list the following if any apply to your dog: Pre-existing or current medical conditions Orthopedic problems i.e. hip dysplasia, arthritis Allergies Medications How does your dog react to strangers approaching your home? How does your dog react to strangers out in public? How does your dog react to other dogs approaching the home? How does your dog react to other dogs out in public? Does your dog fear or dislike any types of people? Does your dog fear or dislike any types of dogs? Is your dog frightened by any noises or objects? 2
Does your dog play off-leash with any other dogs? Briefly describe: Has your dog ever bitten anyone? If yes, what were the circumstances? Has your dog ever bitten another dog? If yes, what were the circumstances? What is your dog s favorite toy(s)? What is your dog s favorite game(s) to play? Is your dog possessive of toys, food or objects? If yes please explain: What is your dog s favorite treat(s)? Can we give your dog treats while in daycare? Is your dog sensitive about any parts of his/her body? Where are your dog s favorite petting spots? Please list any comments about your dog that you feel will be helpful to us: Communications with PUP Can we use pictures of your dog on social media? Yes No Would you be interested in receiving news and information about PUP events and promotions? Yes No How did you hear about PUP? Would you be interested in learning more about caring for your dog? (circle all that apply) Raw Food Diet Information Session Natural Supplements Information Session How to Massage Your Dog Workshop Dog First Aid Course 3
PUP Daycare & Sleepover Policies Petite Urban Pooch ( PUP ), its daycare program ( daycare ) and overnight service ( sleepover ) strive to provide a safe, fun and stimulating social & fitness oriented environment for small breed dogs under 30 pounds or less. To ensure the safety and health of your pet, we require that all our guests comply and agree to the following rules and regulations: AGE: All dogs that are enrolled in daycare or participating in a trial day must be at least 24 weeks of age or older. SEX: All dogs 6 months or older that are enrolled in daycare or participating in a trial day must be spayed or neutered. VACCINATIONS: All dogs that are enrolled in daycare or participating in a trial day 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 6 months of age. We accept titre tests as well as vaccine certificates as proof of immunity. 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 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. PUP 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. Collars, harnesses, and leashes can be left in the daycare buckets for use at the end of the day. BEHAVIOUR: 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 our 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 PUP, its owner, volunteers, and staff shall not be responsible or liable for any lost, stolen, or damaged personal property, belonging to either my dog, or me while on the premises of PUP. 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 PUP 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 PUP. Such determinations shall be made at the sole discretion of Petite Urban Pooch. ENROLMENT FORM: All dogs enrolled in daycare must have a complete, up-to-date, and approved enrolment form on file. If anything changes in terms of your pet s health or your contact information you will provide PUP staff with the changes. FEES: Fees are based on a daily rate for full or half days and on package rates. A full day is not to exceed 11 hours. A halfday is not to exceed 5 hours. Trial days are free of charge for up to 4 hours of assessment. Additional dogs from the same 4
household receive a discounted rate for daycare attendance. Please refer to fee schedule or website (petiteurbanpooch.com) for a complete price list and package options. DAYS AND HOURS: PUP is open Monday and Friday from 7:30 a.m. to 6:00 p.m. and from 7:00 a.m. to 6:00 p.m. Tuesday to Thursday. Staff go off duty at 6:00 p.m. and, depending on the circumstances and amount of notification, there may be 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 PUP. OVERNIGHT CARE: For dogs participating in the Sleepover option the service provides 12 hours of overnight care that can start and continue into the day care program. This care is an in-home service so your pet is not kept in a kennel. Proper care and feeding instructions will be provided to PUP staff to ensure a comfortable stay. 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 PUP s daycare program. VETERINARY CARE: I agree to allow PUP, its owner, volunteers, 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. RESERVATIONS: Reservations are highly recommended. PUP cannot guarantee a space for any dog on a walk in basis. Cancellations with less than 4 hours notice and failure to show for a reservation may be subject to additional fees. For your convenience an online schedule is available via the Facebook site Book It button and on the Schedule Ahead website page. I hereby certify that I have read, understood, and agree to abide by all of the policies, rules, and regulations contained within this document. Name (Print) 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 in the care of Petite Urban Pooch ( PUP ). 2. I further understand and agree that in admitting my dog to PUP, Petite Urban Pooch s representatives 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 Petite Urban Pooch 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 PUP. 4. I further understand and agree that dogs can sometimes receive minor cuts, bites, and scratches at daycare and any problems that develop with my dog will be treated as deemed best by staff and volunteers of PUP, 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 PUP as set forth in the preceding paragraphs and that I have read and understand the conditions, and statements of this agreement. Dated: Printed Name of Owner: Signature of Owner: 6