4925 NW Fruit Valley Rd, Vancouver, WA PH# (360) Fax# (360)

Transcription

1 4925 NW Fruit Valley Rd, Vancouver, WA PH# (360) Fax# (360) This application and vaccine records must be submitted to the office before an interview can be scheduled. OWNER INFORMATION NAME CO-OWNER ADDRESS CITY ZIP CODE PLACE OF EMPLOYMENT HOME PHONE WORK PHONE CELL PHONE OTHER PEOPLE THAT CAN PICK UP YOUR DOG NAME PHONE NAME PHONE NAME PHONE

2 PET INFORMATION NAME BIRTHDAY BREED COLOR NAME BIRTHDAY BREED COLOR MALE / NEUTERED FEMALE / SPAYED MALE / NEUTERED FEMALE / SPAYED When or where did you get your dog? (Shelter/breeder, etc.) If adopted, do you have any history on your dog? VETERINARIAN and HEALTH INFORMATION CLINIC / HOSPITAL NAME PHONE REQUIRED IMMUNIZATIONS Please fill in due dates and have Veterinarian fax vaccine history, rabies certificate and spay/neuter certificate to: (360) Distemper / Parvo Bordatella / Kennel Cough Rabies Due again on this date Due again on this date Due again on this date Animal Control requires us to keep a copy of your dog s rabies certificate on file. This is a legal document signed by your veterinarian. A copy or your receipt or your dog s rabies tag is not valid to meet this county requirement. Monthly flea control is required continuously for attendance at daycare. Flea collars are not allowed! It is your responsibility to keep your dog parasite free. Keeping your dog on an effective flea control program (Frontline, Advantage, Revolution, not a grocery store product) virtually eliminates the risk of him or her picking up fleas anywhere including your yard, the vet s office, the dog park and especially here at doggy day care. What do you use on your dog? LIST OF MEDICATIONS MY DOGS TAKES Is your dog allergic to any food / treats / medicine?

3 Is your dog allergic to bee / wasp stings? What do you give for this? Any previous medical conditions or surgeries? What brand / flavor of dog food does your dog eat? If you would like your dog to be fed at lunch time, please provide food in a labeled zip lock baggie or bring several days of food in a Rubbermaid cereal container with pets name on it. We will send it home with you to be refilled when it is gone. Can we give your dog a healthy snack or treat during the day? Any other medical / health or feeding issues we should know about? DOG INFORMATION Is your dog housebroken? Has your dog been to daycare before? Has your dog been to dog parks before? What facility? How did he/she do? How would you describe your dog s activity level? Low Medium High Is your dog shy of people / dogs they don t know? Has your dog ever been in a dog fight? Has your dog ever bitten another dog? If yes, did the bite puncture or tear the skin? Has your dog ever bitten a person? If yes, did the bite puncture or tear the skin? Has your dog had obedience training? If yes, which type: Class Home Professional Does your dog jump fences or enclosures? Does your dog try to dig to get out? Where does your dog stay when home alone? (Free range of home, crate, confined to room, backyard, outside kennel, etc.) Does your dog ever guard toys or food?

4 BOARDING INFORMATION Have you boarded your dog before? What facility? What kind of kennels were they in at night? How do they do when boarding? Does your dog destroy toys or bedding? Does your dog show anxiety when in a kennel? (trying to dig or climb out) Does your dog have accidents while in the kennel? Please bring all food in labeled zip lock bags or sealed container. ABOUT DAYCARE Your dog is going to have LOTS of fun! While at daycare, your dog will get slobbered on, dirty from rolling around outside in the grass, possibly wet from the rain, sprinklers or swimming pools. We will do our best to dry them, spray with waterless shampoo and a quick brush out if necessary sometime in the late afternoon. Please keep a towel or blanket in your car for these wet times. If your dog is vomiting or has diarrhea or is limping or hurt, please do not bring them to daycare unless prior arrangements have been made. Your dog must be 4 months of age or older, and must be spayed or neutered by 6 months of age. Please bring your dog into the daycare on a leash or in a crate and all dogs must have a collar on. For safety reasons, no choke collars, gentle leaders, prong collars, flea collars or harnesses are allowed on your dog while playing. Reservations for daycare are requested in advance. We may fill to capacity during the day, so it is recommended you call at least one day in advance. We may take drop offs if there is space available. If your dog is not attending on a scheduled day, please call so other dogs can make a reservation. Half days are considered 4 hours or less. Anything over 4 hours is considered a full day. You cannot combine pre paid daycare packages with boarding. All daycare services are pre-paid. We accept Cash, Check, Visa and Mastercard only. You may choose to buy one of our discounted packages, or you can pay as you go. (Bounced checks will be assessed an additional fee of $25.00).

5 AGREEMENT This is an Agreement between Tails R Waggin Doggy Daycare, Inc, doing business as Tails R Waggin, and the Owner/Guardian whose name is and whose signature appears on Page 2 (hereinafter called Owner/Guardian ). Following are the terms of service for the stay of the Owner/ Guardian s dog (Name) (the Dog ) as a reservation or daycare stay at Tails R Waggin Doggy Daycare, Inc.. By signing below, in consideration of the services rendered by Tails R Waggin Doggy Daycare, Inc. to the Dog(s), Owner/Guardian acknowledges reading, understanding, and accepting the statements herein. AGREEMENT TO PARTICIPATE AND LIABILITY WAIVER: Owner/Guardian understands certain activities that the Dog may participate in, including daycare, grooming, training, boarding, one-on-one play, movement within and outside the facility, involve risk and possible injury, including but not limited to: exposure to parasites, viruses, and other medical conditions passed from dog-to-dog or person-to-dog; sprains, strains, bites, broken bones; fatigue, dehydration, nicks, cuts, loss of Dog or death. Owner/Guardian further understands that not each and every potential risk can be listed above but, nonetheless agree that the benefits associated with dog socialization outweigh the possible risks, therefore, Owner/Guardian hereby voluntarily releases, forever discharges, and agrees to hold harmless and indemnify Tails R Waggin Doggy Daycare, Inc. and its agents, successors, heirs, from any and all liability, claims, demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with the Dog s participation in activities at Tails R Waggin, including those allegedly attributable to the negligent acts or omissions of Tails R Waggin or their staff. Further, Owner/Guardian understands that Owner/Guardian may be exposed to certain risks when bringing the Dog to participate in activities at Tails R Waggin Doggy Daycare or when picking up the Dog from participating in activities at Tails R Waggin Doggy Daycare. Such risks may include property damage and/or physical injury inside or outside the facility, such as from falling, slipping, illness, and/ or dog bites. Therefore, Owner/Guardian hereby voluntarily releases, forever discharges, and agree to hold harmless and indemnify Tails R Waggin Doggy Daycare, its agents, successors, heirs from any and all liability, claims, demands, actions, or rights of action, which are related to, arise out of, or are in any way connected with the Dog s participation in activities at Tails R Waggin Doggy Daycare including those allegedly attributable to the negligent acts or omissions of Tails R Waggin Doggy Daycare or their staff. AUTHORIZATION OF MEDICAL CARE: If the Dog is ill or injured while participating in activities at Tails R Waggin Doggy Daycare, we will make every reasonable effort to reach Owner/Guardian pursuant to the contact information Owner/Guardian have provided Tails R Waggin. However, if Tails R Waggin Doggy Daycare is unable to reach Owner/Guardian, Owner/Guardian grants consent to Tails R Waggin Doggy Daycare to seek appropriate veterinary care and Owner/Guardian accepts responsibility for any and all associated expenses. Tails R Waggin Doggy Daycare will not pay any portion of veterinary expenses associated with seeking medical care for the Dog if so necessary. In the event of the Dog s death the Owner/Guardian or the Owner/Guardian s emergency contact will be notified immediately. CONTAGIOUS DISEASES & VACCINATIONS: Owner/Guardian specifically represents to Tails R Waggin Doggy Daycare that, to Owner/Guardian s knowledge, the Dog has not been exposed to any contagious diseases within the 30 days period prior to checkin. Owner/Guardian understands that each time the Dog is brought to Tails R Waggin Doggy Daycare, Owner/Guardian is recertifying that the Dog is in good health and has not had any communicable illness of any kind for 30 days prior to check-in. Owner/Guardian also confirms the Dog meets Tails R Waggin Doggy Daycare s vaccination requirements during the Dog s stay. ALLERGIES, SPECIAL DIETS, MEDICATIONS: Owner/Guardian agrees to disclose to Tails R Waggin Doggy Daycare any allergies the Dog may have. Owner/Guardian further agrees to disclose to Tails R Waggin Doggy Daycare any special dietary needs or medications the Dog may require if necessary during activities at Tails R Waggin Doggy Daycare. PHOTOGRAPHS AND STATEMENTS: Owner/Guardian authorizes use of the Dog s visual image(s) and statements in newsletters, posters, and other materials. BEHAVIOR: Owner/Guardian affirms that the Dog does not have a history of biting or harming people or other animals. AGREEMENT TO PAY: Tails R Waggin Doggy Daycare accepts check, cash, or credit cards. Owner/Guardian agrees to pay the service rates in effect for the Dog s participation in activities at Tails R Waggin Doggy Daycare. Owner/Guardian further agrees to pay for any additional services requested at Tails R Waggin Doggy Daycare. A valid credit card must be kept on file at all times. Charges not paid in advance will be charged to Owner/Guardian s credit card. All services must be paid in full before the Dog will be released to Owner/Guardian or proper payment arrangements are agreed upon by both parties (Owner/Guardian & Tails R Waggin Doggy Daycare).

6 DAMAGE: Owner/Guardian accepts the responsibility of paying for any damage to facility, property, and/or equipment caused by the Dog. RIGHT TO DECLINE: Owner/Guardian understands that Tails R Waggin Doggy Daycare reserves the exclusive right to decline participation or to terminate participation in activities at Tails R Waggin Doggy Daycare to any Dog at any time for any reason. VALID DATES: These agreements, waivers, and authorizations will remain valid and in force as long as and whenever the Dog participates in any activity at or with Tails R Waggin Doggy Daycare. ACKNOWLEDGEMENT: This Agreement contains the entire agreement between the parties. All terms and conditions of this Agreement shall be binding on the heirs, administrators, personal representatives and assignees of the Owner/Guardian and Tails R Waggin Doggy Daycare. Any controversy or claim arising out of or relating to this Agreement, or the breach thereof, or as the result of any claim or controversy involving the alleged negligence by any party to this Agreement, shall be settled in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by an arbitrator may be entered in any Court having jurisdiction thereof. The arbitrator shall, as part of the award, determine an award to the prevailing party of the costs of such arbitration and reasonable attorney s fees of the prevailing party. The arbitrator(s) shall apply Washington law to the merits of any dispute or claim, without reference to conflicts of law rules. The parties hereby consent to the personal jurisdiction of the state and federal courts located in Washington and agree that such courts shall have the sole and exclusive jurisdiction for any action or proceeding arising from or relating to this Agreement or relating to any arbitration in which the parties are participants. Signature of Owner Date How did you hear about us? Drive by Referral (who should we thank) Internet search Event