Dogville Daycare Application Form
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1 Dogville Daycare Application Form We love dogs and strive to provide the best daycare and boarding experience possible. Dr. Delana McNac and the team here at Dogville Daycare & Boarding are thankful for the opportunity to provide a comfortable and safe place for your beloved dog. If you have any questions about the form below, please do not hesitate to call (918) or us at info@dogville-daycare.com. Thank you for your interest in Dogville Daycare & Boarding. (Please answer all questions. Please fill out one form for each dog) CONTACT INFORMATION Your Name: Date: Street Address: Cell: Work Number: Address: EMERGENCY CONTACT IF WE CAN T REACH YOU (NAME AND NUMBER of CONTACT) Please tell us about how you heard about us Referral--Please give the name, so we can thank them. Or, did you find us through! Tulsa Pets Magazine! Tulsa Youth Symphony Program! Tulsa People Magazine! Neighborhood Newsletter! Dogville Daycare Facebook Page! Dogville Daycare Website Other: TELL US ABOUT YOUR DOG Name: Breed: Age: How long have they lived with you? Is your dog (check one): spayed/neutered? Intact? Approximate Weight: Veterinarian/Veterinary Hospital s Name: Address and telephone number:
2 Date of most recent visit and results: Any current medical issues we should be aware of? Name/brand of Food: Dry or Canned: How often do you feed and how much at a time?! Once Daily! Twice Daily! Free Feed! Other Any Medications to administer while your dog is our guest? If so, please list below: If more space or information is needed, please feel free to attach any additional paperwork. Is your dog current on vaccinations? (please check all that apply)! Rabies! Distemper/Parvovirus! Bordetella (Kennel Cough) A COPY OF YOUR DOG S MOST RECENT VACCINATION RECORD MUST BE SENT TO US PRIOR TO YOUR DOG S FIRST VISIT TO DOGVILLE. OUR ADDRESS IS reservations@dogvilledaycare.com AND OUR FAX NUMBER IS WE REQUIRE OUR GUESTS TO RECEIVE A BORDETELLA VACCINATION EVERY SIX MONTHS. Current on heartworm prevention and monthly flea and tick prevention? Yes No Please note, if fleas are found on any daycare or boarding dog, a one-time dose of Capstar will be administered at owner s expense, and the dog isolated until fleas are no longer detected. HISTORY The answers to the following questions will help us gauge our ability to provide the most appropriate, enjoyable environment for your dog. We know this is extensive, but please answer as completely as possible. Previous Daycare Experience Has your dog ever attended daycare before? Yes No If your answer is yes: How did your dog respond? How did you feel about the experience? Please tell us any positive or negative observations. What led you to look for a new daycare? If your answer is no:
3 How do you expect your dog to respond to the daycare experience? Enjoy themselves and look forward to making new friends? Be nervous? Settle in quickly? If you re not sure, that s OK too. Do you have any concerns about your dog coming to daycare? Please be specific/ Does your dog have any physical limitations or precautions we need to know about? Does your dog have any dietary restrictions or allergies? Can they have house treats? Resource Guarding Dogs Does your dog have any toys or possessions they prefer not to share with other dogs? How does your dog let other canines know that they don t want to share? Please be specific. When your dog is resting, how do they respond if another dog approaches them? How does your dog react when another dog approaches you? If you have food, treats, or toys, does this reaction change? Resource Guarding Humans Does your dog have any toys or possessions they prefer not to share with humans? How does your dog let humans know that they don t want to share? Please specify. When resting, how does your dog respond to a human approaching? How does your dog respond when another human approaches you? If you have food or treats, does this reaction change? Dog-Dog Socialization How many canine friends does your dog have? One or two? A few? Social butterfly? How often does your dog have a chance to meet new friends? Rarely, occasionally, or weekly? How does your dog warm up to new canine acquaintances? Quickly? Slowly, but during the first meeting? Does it take several meetings? How do they respond during the first meeting?
4 When your dog meets a new friend, how is your dog most comfortable? Touching and interacting with each other? Being near, but not interacting? At a distance? Are they comfortable at all? Has your dog ever had an altercation with another dog? Please be honest. Did it involve: Males, Females, specific breed or certain size of dog? Puppies, adolescent or young dogs, or an older dog? A particular style of play (chasing, et cetera)? Too close of a distance? Too long of a greeting? Sniffing your dog s rear end? Please tell us what happened: Dog Play--- This helps us determine who will be the best fit for your dog What kind of dogs does your dog like to play with? (check all that apply)! Small Dogs?! Medium Sized Dogs?! Big Dogs?! Older Dogs?! Younger Dogs?! Energetic Dogs?! Laid Back Dogs? Are there any kinds of dogs that your dog prefers NOT to play with? (check all that apply)! Small Dogs?! Medium Sized Dogs?! Big Dogs?! Older Dogs?! Younger Dogs?! Energetic Dogs?! Laid Back Dogs? Does your dog ever use any of these play behaviors or signals when interacting with other dogs? Play bow: Raised play paw: Fast tail wag: Ears back: Open, smiling mouth: Investigative greeting: Bouncy, exaggerated movement: Chasing with pauses or role reversals? Wrestling with pauses and role reversals?
5 Are there any other behaviors or signals you have noticed? Barrier Frustration How does your dog respond when they see another dog while they are on a leash? How does your dog respond when they see another dog when your dog is behind a fence? Looking out the window? In the car? Has your dog ever climbed, dug, or jumped a fence or barrier? What kind (example, chain-link, et cetera)? Dog-People Relations Does your dog warm up to new people immediately, rather quickly, or does your dog need some time? Is your dog comfortable with the following actions? Does your dog love it, tolerate it, or hate it? How can you tell? Putting your dog s collar on and taking it off: Putting his leash on and taking it off: Being picked up, petted, or hugged: Has your dog ever snapped at, or bitten, a person? Did the incident involve: Male, female, or a child? Toys or other possessions? Food? Space, such as a bed, couch, et cetera? Being approached? Being reached for, picked up, or petted? Please describe what happened in this situation. LIABILITY WAIVER & POLICIES (Continued and Signature required on next page) 1. (Dogville Daycare & Boarding) will endeavor to offer only sound, safe, and responsible care for my dog(s). However, I have been told that in order for my dog(s) at attend daycare or boarding that they must be vaccinated every 6 months for Kennel Cough. I also understand the risks inherent in boarding my dog, including but not limited to interactions with other dogs and potential exposure to disease and parasites and that just because my dog(s) have been vaccinated for kennel cough that does not mean they are 100% protected from getting the disease. Further, I am and will remain responsible for the actions of my dog at all times and I hereby agree to indemnify and hold harmless (Dogville Daycare & Boarding) of any and all claims of illness, injury, expense, costs, or damages
6 caused by the actions of my dog while under (Dogville Daycare & Boarding s) care. I have been told by (Dogville Daycare & Boarding) and understand the inherent risks of owning a dog, including but not limited to the risk of dog bites to myself or others. I recognize that (Dogville Daycare & Boarding) is not responsible for any unintentional errors, omissions, or incorrect assertions. I understand that the recommendation of any other product or service is not a guarantee of my satisfaction with that product or service. 2. I authorize emergency medical care to be provided for my dog(s) by the above-named veterinarian, or an appropriate alternate to be determined by (Dogville Daycare & Boarding) in the event that my regular veterinarian is not available or that closer care is required. I will reimburse (Dogville Daycare & Boarding) for any charges related to emergency care. I authorize (Dogville Daycare & Boarding) to administer or seek 1 st aid and resuscitative care for my dog(s) as determined appropriate by (Dogville Daycare & Boarding) and I agree to indemnify and hold harmless (Dogville Daycare & Boarding) for all and any results thereof. I DO NOT authorize (Dogville Daycare & Boarding) to administer or seek 1 st aid and resuscitative care for my dog(s) as determined appropriate by (Dogville Daycare & Boarding) and I agree to indemnify and hold harmless (Dogville Daycare & Boarding) for all and any results thereof. 3. Payment Policy: Payment is due at the time dog(s) is/are picked up from Dogville. Credit cards and cash are accepted for payment. Checks must be pre-approved by management. Returned checks will be charged a $25 fee. 4. Cancellation Policy: Cancellations are to be submitted at least 24 hours in advance of reservation. 5. Grooming Policy: Any dog that arrives with fleas will be given a dose of Capstar at owner s expense ($25/dose) and kept quarantined from other dogs until fleas are gone. 6. Stress-induced diarrhea. I understand that boarding dogs may arrive with or develop diarrhea as a condition of stress related to separation from an owner and the uncertainty of the owner s return. This may result in a need to supplement or modify the dog s normal diet with products that contain high fiber content and probiotics to regain the normal balance of intestinal flora during a prolonged stay. When this occurs, I understand that I will be notified by Dogville staff and that there will be an additional charge for each feeding containing these ingredients. If the diarrhea progresses to the point that medical intervention is needed, I will be informed by Dogville Staff (or my emergency contact will be notified in the event I cannot be reached) and I will be responsible for any additional costs related to veterinary care or prescribed medication. This contract is validated by the signatures below in total and as approval for future services without additional written authorization. Dog Guardian Date Boarder Date Thank you! Dogville Daycare & Boarding Address 9525 E. 47th Place Tulsa, Oklahoma Hours of Operation Monday Friday: 7 a.m. 7 p.m. Saturday: 8 a.m. 5 p.m. Sunday: Closed to the public INFO@DOGVILLE-DAYCARE.COM RESERVATIONS@DOGVILLE-DAYCARE.COM Phone Number (918) Fax Number (918)
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