The Barking Orange Daycare Application (Updated September 2015) Contact & General Information Your Name Street Address City, State, ZIP Code Home Phone Cell Phone Work Phone E-Mail Address How Did you Hear About Us? Your Dog s Name Male or Female Date of Birth Spayed / Neutered Breed Color Weight Vet s Name Vet s Phone Number Pet Personality Profile How long have you had your dog? Where did you get your dog? If you rescued your dog, do you have any information on your dog s history? Please indicate Yes or No to help describe your dog s personality Playful Shy Affectionate Outgoing Submissive Insecure
Gentle Mouthy Avid Barker Quiet Jumpy Excitable Describe your dog s activity level: Low Medium High Is your dog crate trained? YES NO If YES, does your dog like being in his/her crate? YES NO Please indicate Yes or No to help describe the situations where your dog may become unfriendly or react in a negative manner Grabbing collar Being removed from furniture Touching ears Touching tail Removing a toy from mouth Hugging Being touched while sleeping Touching paws Being pet OTHER (please indicate) Has your dog gone to daycare before? If yes, please describe. Has your dog ever bit another dog? If yes, please describe. Has your dog ever been bitten by another dog? If yes, please describe. Is your dog a resource guarder (Food aggressive, toy aggressive, protective of people?) If yes, please describe Is your dog sensitive to noise? Does your dog like children? Does your dog have any health issues? If yes, please describe. Does your dog have allergies? If yes, please describe reaction and allergy.
Does your dog have any dietary restrictions? Does your dog go to dog parks? If yes, has he or she ever exhibited aggressive behavior towards other dogs/people at the park such as mouthing, teething or raising hackles? What does your dog do when you are not at home? Are there any people your dog dislikes or fears? How does your dog react to small dogs or puppies? Has your dog ever growled or snapped at anyone who has tried to take food or toys away? Has your dog ever climbed a fence? Interests Tell us what your dog likes to do! Indicate with an X or check mark. Running Playing with balls Playing with toys Jumping Tricks Eating Sleeping OTHER
Special Instructions or Other Important Stuff we should know Daycare Schedule Let us know what days you are planning on bringing your dog to The Barking Orange. Mondays Tuesdays Wednesdays Thursdays Fridays Half Days Person to Notify in Case of Emergency (in case we can t reach you) Name Street Address City, State, ZIP Code Home Phone Cell Phone Work Phone E-Mail Address Name Street Address City, State, ZIP Code Home Phone Cell Phone Work Phone E-Mail Address
Agreement and Signature By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if my dog is accepted to The Barking Orange, any false statements, omissions, or other misrepresentations made by me on this application may result in an immediate dismissal. Name (printed) Signature Date The Barking Orange Rules & Policies All potential customers are required to complete an application and participate in a screening/interview prior to joining The Barking Orange. Current vaccination records must be provided to The Barking Orange by the first day of daycare. All dogs must continue to be up to date with shots on an annual basis and provide The Barking Orange with updated records. We do ask that you give your vet permission to release records to us so that we can easily obtain them going forward. All dogs must be spayed or neutered at 6 months in order to participate in daycare Payment is due on the day of service. Pre-paid services are also accepted. Packages expire 1 year after date of purchase. There are no refunds. Dogs admitted to The Barking Orange should attend daycare monthly and The Barking Orange reserves the right to re-interview dogs that have been out of daycare for more than a month. Sick dogs should remain home and out of daycare. The Barking Orange reserves the right to send home a dog we may feel is sick. Customers should communicate illnesses to The Barking Orange and we will do the same. Customers are required to keep their dog on a leash or in a crate upon entering and leaving The Barking Orange facilities and parking lots. Barking Orange customers will abide by all leash law and dog waste pick up protocols while in the neighborhood. Your dog may be removed from daycare for fighting, leaving a mark on a dog or staff member, being overly stressed out, not listening, and or if novelty has worn off. Please sign below indicating you have read and agreed to our rules and policies. Name (print) Signature Date
The Barking Orange Pet Care Agreement 1. I understand that The Barking Orange, LLC has relied upon my representation that my dog is in good health and has not injured or shown aggressive or threatening behavior to any person or dog in admitting my dog for services at The Barking Orange, LLC facility. 2. I further understand that The Barking Orange, LLC owners and staff will not be liable, financially or otherwise, for injuries to my dog, myself, or any property of mine while my dog is participating in services provided by The Barking Orange, LLC. I hereby release The Barking Orange, LLC of any and all liability of any kind arising from my dog s participation in any and all services provided by The Barking Orange, LLC. 3. I further understand and agree that any problems with my dog, including behavioral, medical or otherwise, will be treated as deemed appropriate by the staff of The Barking Orange, LLC at their sole discretion, and in what they view as the best interest of the dog. I understand that I assume full financial responsibility and all liability for any and all expenses involved in regards to the health and well-being of my dog. 4. I further understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I understand that while the socialization and play is closely and carefully monitored by The Barking Orange, LLC staff to prevent injury, it is still possible that during the course of normal play my dog may receive minor abrasions from contact with other dogs. 5. I further understand by allowing my dog to participate in services offered by The Barking Orange, LLC, I hereby agree to allow The Barking Orange, LLC to take photographs, video or use images in print form or otherwise of my pet for publication and or promotion. 6. I further understand that I am solely responsible, financially or otherwise, for any harm or damage caused by my dog while my dog is attending any services provided by The Barking Orange, LLC. 7. I further understand that The Barking Orange, LLC reserves the right to refuse admittance of my dog at any time if problems shall arise from my dog s participation at The Barking Orange, LLC. 8. I further understand that if a medical emergency, as deemed by staff of The Barking Orange, LLC occurs involving my pet, I hereby authorize the staff to seek any and all medical attention necessary at the facility the staff deems appropriate. I also agree to be financially responsible for any and all medical treatment my pet receives as a result of this action. 9. I further understand that if my dog is not picked up on time or by a date specified in a separate agreement I hereby authorize The Barking Orange, LLC to take whatever action is deemed necessary for the continuing care of my dog. I will pay The Barking Orange, LLC the cost of any such continuing care of my dog. I understand that if I do not pick up my dog, The Barking Orange, LLC will proceed according to the guidelines provided by the New York State Article 26, Chapter 353 & 353-a, Cruelty to Animals; procedure for handling. I also acknowledge that I will be fully responsible for all attorneys fees and associated costs if I abandon my dog. Name (print) Signature Date