Doggie Day Care Application

Parent's Name

Email

Address 1

Address 2

City

State

Zip / Post Code

Home Phone:

Cell Phone:

Work Phone

Pet's Name

Birth Date:

Weight (lbs)

Breed

Color

Sex
 Male Female

Is your pet spayed/neutered?
 Spayed/Neutered NOT Spayed/Neutered

Emergency Contact

Emergency Contact Name

Relationship

Home Phone

Cell Phone

Work Phone

Veterinarian Name

Address 1

Address 2

City

State

Zip / Post Code

VACCINATIONS ARE REQUIRED, COPIES OF VETERINARIAN RECORDS MUST BE ON FILE

Authorized Persons For Pick-Up and Drop-Off (Besides yourself, they may be required to show ID)

Name

Relationship

Home Phone

Cell Phone

Work Phone

Dog Behavior Questions (Please answer all questions below to the best of your knowledge).

Is there any PERSON, TYPE OF DOG or SITUATION your dog seems to have a problem with?

If yes, please explain:

How long have you had your dog?

Where did you get your dog?

Has your dog ever growled or bit a Person or Dog?

If yes, please describe:

Can you take food away from your dog without growling?

Will your dog share toys with dogs or humans?

Has your dog ever jumped a barrier or fence?

If yes, please describe:

Are there any areas on your dog’s body where they DO NOT like to be touched by Humans?

Has your dog ever socialized with a large group of dogs? (8+)

If yes, in what atmosphere?

What else should we know about your dog?

DAYCARE REQUIREMENTS. My dog meets the following Daycare requirements he/she has successfully completed the behavioral assessment is spayed/neutered (if over six (6) months of age); is current on all vaccines is in good health and free of fleas, ticks and parasites with a copy of the current veterinarian records; is not aggressive or protective of toys; meets all other municipal or state licensure and other requirements; their belongings are all labeled with first and last name. I have completed the Doggie Daycare Enrollment Application. My Dog will Enter & Exit HPI on leash and collar. I understand that my dog will be in a cage, kennel, or run from 7am-9am (pre-camp), 12pm-1pm (afternoon nap), 4pm-6:30pm (post-camp). Camp playtime is from 9am-12pm & 1pm-4pm.

ACCEPTANCE AND ACKNOWLEDGEMENT OF DAYCARE PARTICIPATION RISK. I fully understand that (a) there are inherent and potential risks involved with interactions between humans and dogs, as well as between dogs and other dogs, which may result in property damage or bodily injury, including permanent disability, sickness or death to human or dog and (b) there may be other risks not know to the owner or staff nor readily foreseeable at this time (Collectively “Risks”) I fully accept and assume all risks and responsibility for all risks, including, without limitation, all loses, costs and damages incurred as a result of me or my dog’s participation in the event.