Address: City Province Postal code Home Phone ( ) - Work Phone ( ) - Address:

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Chad Armstrong
5 years ago
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1 DOG DAYCARE APPLICATION FORM Yur Name: cde Hme Phne ( ) - Wrk Phne ( ) - Address: Emergency Cntact: Name: cde Hme Phne ( ) - Wrk Phne ( ) Veterinarian: Name: Phne ( ) - cde PET INFORMATION: Name: Sex: M / F Spayed/Neutered: Y / N Age: Birthday: Breed: Clr: Weight: Feeding Schedule: Brand and Type f Fd: Is yur dg allwed t have treats? Y / N (what type) _ Where did yu get this dg?

2 Hw lng have yu had him/her? If yu have nt had him/her frm puppy hd, what d yu knw f its prir histry? Please describe yur dgs verall temperament: Hw des yur dg react t ther dgs? Has yur dg every participated in play at a dg park? Y / N If yes hw did he/she react with the ther dgs? Des yur dg have any kinds f peple he/she autmatically fears r dislikes? Y / N Des yur dg have any kinds f dg that he/she autmatically fears r dislikes? Y / N Has yur dg ever bitten smene? Y / N Has yur dg ever been in a fight r bitten anther dg? Y / N What knwn behaviral prblems des yur dg have? Is yur dg husebrken r crate trained? Des yur dg play with tys? Y / N Is yur dg ty pssessive? Y / N

3 Describe: Has yur dg shared tys/fd/water with ther dgs befre? Y / N Were there any prblems? Has yur dg ever received any frmal training? Y / N What cmmands des yur dg knw? - Bathrm Cmmand: Quiet Cmmand: Play Cmmand: Des yur dg have any health cncerns that yu are aware f? Y / N Des yur dg have any medical restrictins n his/her activities? Y / N Is yur dg currently n any medicatin? Y / N Des yur dg have any allergies? Y / N Des yur dg like t receive brushings? Y / N Hw des yur dg react t getting his/her nails clipped? Des yur dg have any areas n his/her bdy that he/she des nt like t be tuched? Y / N

4 Des yur dg receive flea and tick preventative? Y / N Is there anything else that yu believe we shuld knw abut yur dg? When wuld yu like t start?. Please cntact yur veterinarian fr required certifactes. rabies vaccinatin certificate; DHPP (distemper, hepatitis, parainfuenza and parvvirus) certificate; annual brdatella certificate; spay r neuter certificate fr dgs ver 8 mnths; We als require the use f mnthly flea and tick preventin medicatin (May t Nvember). Yur veterinarian can cpies f these certificates directly t us. ***Please read the next sectin carefully as it invlves a waiving f certain rights*** MEDICAL RELEASE FORM This is a required frm fr all The Cllar Club participants receiving services. First and fremst the safety and well being f yur pet(s) is f the highest imprtance. Insuring that yur pet remains safe and well cared fr is ur first respnsibility and as such we take it very seriusly. We d ur best t have ur pet parents screen fr pre-existing health cnditins but sme factrs may be beynd ur cntrl. In the event that a medical emergency arises while a pet is at ur facility r participating in a service that we prvide it is imperative that we are immediately able t get them medical treatment at the clsest available facility. We will call ahead t the veterinary ffices in clsest prximity gegraphically t us t insure they can handle the emergency present. Yur pet will be rushed t the clsest available facility fr treatment and yu will be ntified. We ntify the wner after we have secured a medical treatment center fr the animal t avid delays that may be

5 caused by emtin n the part f the wner. Our gal is t get yur pet medical attentin as quickly as humanly pssible, and any distractins may interfere with that prcess. Fr that reasn, it is a requirement t have ur pet parents sign this frm. I understand that in the event f a medical emergency that The Cllar Club, at its sle discretin, deems t need the immediate attentin f a licensed veterinarian, I authrize The Cllar Club t seek medical attentin at the clsest available veterinary facility. I further agree that I am financially respnsible fr any medical treatment my pet(s) receives as a result f a medical emergency while attending services prvided by The Cllar Club Signature f Owner Printed Name Date WAIVER OF LIABILITY Name: Cde Hme Phne ( ) - Wrk Phne ( ) Dg s Name: Age: Breed: 1. I further understand that The Cllar Club has relied upn my representatin that my dg is in gd health and has nt injured r shwn aggressin r threatening behavir t any persn r dg in admitting my dg fr services at their facility. 2. I further understand that their wners, staff, partners and vlunteers, will nt be liable, financially r therwise, fr injuries t my dg, me r any prperty f mine while my dg is participating in services prvided by The Cllar Club. I hereby release The Cllar Club f any liability f any kind arising frm my dgs participatin in any and all services prvided by The Cllar Club. 3. I further understand and agree that any prblems with my dg, behaviral, medical r therwise will be treated as deemed best by staff f The Cllar Club in their sle discretin, and in what they view as the best interest f the animal. I understand that I assume full financial respnsibility and all liability fr any and all expenses invlved in regards t the behavir and health f my dg. 4. I further understand that there are risks and benefits assciated with grup scializatin f dgs. I agree that the benefits utweigh the risks and that I accept the risk. I desire a scialized envirnment fr my dg while attending services prvided by The Cllar Club and while in their care. I understand that while the scializatin and play is clsely and carefully mnitred by The Cllar Club staff t prevent injury, it is still pssible that during the curse f nrmal play my dg may receive minr nicks and scratches frm rughhusing with ther dgs. Any injuries t my dg will be pinted ut by staff upn pick-up.

6 5. I understand by allwing my dg t participate in services ffered by The Cllar Club I hereby agree t allw The Cllar Club t take phtgraphs r use images f my pet in print frm r therwise fr publicatin and/r prmtin. 6. I further understand that I am slely respnsible, financially r therwise, fr any harm r damage caused by my dg while my dg is attending any services prvided by The cllar Club 7. I understand that if my dg is nt picked up n time r by a date specified in a separate agreement I hereby authrize The Cllar Club t take whatever actin is deemed necessary fr the cntinuing care f my dg. I will pay The Cllar Club the cst f any such cntinuing care upn demand by The cllar Club Signature f Owner: Date: Printed Name:

Recurring Rental Agreement for Recovery Groups Using the Fellowship Hall

Recurring Rental Agreement for Recovery Groups Using the Fellowship Hall Recurring Rental Agreement fr Recvery Grups Using the Fellwship Hall The grup ( the Grup ) agrees t rent Rm N. at the Fellwship Hall ( the Hall ) n (day/s) frm (start time) t (end time). This agreement