BARK-N-BUDDIES DOGGIE DAYCARE, LLC APPLICATION. Owner(s) Name Date. Address. City State: Zip. Home Phone Work Phone Work Phone

Transcription

1 APPLICATION Owner(s) Name Date Address City State: Zip Home Phone Work Phone Work Phone Cell Phone Cell Phone Emergency Contact Phone Emergency Contact Phone Veterinarian Clinic Veterinarian Address Phone How did you hear about Bark-N-Buddies Doggie Daycare? PET(S) INFORMATION Dog's Name Breed Color Sex Age Birth date Spayed or Neutered (circle one) Dog's Name Breed Color Sex Age Birth date Spayed or Neutered (circle one) Dog's Name Breed Color Sex Age Birth date Spayed or Neutered (circle one) Dog's Name Breed Color Sex Age Birth date Spayed or Neutered (circle one) Page 1

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3 Dog Name If adopted or rescued do you have knowledge of your dog's history? Describe dog's condition at time of adoption/ rescue How long has dog been with you? HEALTH INFORMATION: Owners are required to provide proof of current vaccinations. We do not accept any dogs in our facility without current vaccinations. We require negative fecal test results every 6 months. Does your dog need to be given medications, have any allergies or other sensitivities? Yes or No (circle one) If yes, please provide details about allergies/sensitivities and/or instructions for giving medication Does your dog have any physical limitations such as hip dysplasia? Yes or No (circle one) If yes, please describe what restrictions should be placed on your dog s activities/movements GROOMING: Does your dog like to be brushed/ combed? Yes or No (circle one) Does your dog have any sensitive areas on their body? Yes or No (circle one) If yes, please explain Page 3

4 GROOMING (continued): Where are your dog s favorite petting/scratching spots? How does your dog react to nail trimming? What flea product do you use on your dog? How often do you apply flea product? BEHAVIOR: Has your dog been to daycare before? Yes or No (circle one) If yes, where Describe dog s behavior around children Are there other pets in your household? Yes or No (circle one) If yes, list types How does your dog get along with other pets? Does your dog exhibit fear of certain items or noises? Yes or No (circle one) If yes, what kinds? Describe how your dog reacts to visitors entering your home or yard Page 4

5 Page 5 BARK-N-BUDDIES DOGGIE DAYCARE, LLC BEHAVIOR (continued): Does your dog bark or growl at anyone passing by your home or yard area? Describe the type of people your dog seems to automatically fear or dislike How does your dog react to puppies? Has your dog ever bitten anyone, human or animal? Yes or No (circle one) If yes, describe Does your dog have any problems in the following areas Mouthing /Barking / Jumping / House Training / Digging / Other (circle all that apply) Explain Has your dog ever had obedience training? Yes or No (circle one) If so, what commands does your dog know? Has your dog ever been in a crate? Yes or No (circle one) Has your dog growled or snapped at anyone near their food or toys? Yes or No (circle one) If yes, please explain

6 BEHAVIOR (continued): Is your dog: nervous, aggressive, fearful, calm, standoffish, playful, and/or shy? (Circle all that apply) Does your dog: frighten easily, come to name, ignore commands, and/or share toys? (Circle all that apply) Is there training you would like us to reinforce with your dog? What comments about your dog might be helpful to our staff? Page 6

7 POLICIES AND PROCEDURES AGREEMENT 1. AGREEMENT: All pets must have a complete, up to date and signed agreement on file. Client must inform Bark-N- Buddies of any changes that will affect this agreement. 2. AGE: All pets must be at least 10 weeks of age. (Proof of age maybe requested) 3. BEHAVIOR: Clients must inform Bark-N-Buddies staff of their pet s behaviors. All dogs must be non-aggressive with humans, other dogs, around toys and food. By signing this agreement Client declares his/her dog(s) has not harmed, shown aggression, or shown threatening behavior towards any person or dog. If, after signing this agreement, the pet(s) exhibits any of the aforementioned behaviors, Clients must inform Bark-N-Buddies. Bark-N-Buddies reserves the right to refuse service to pet(s) upon learning of or observing any of the above behaviors. 4. SEX: All dogs joining our daycare must be spayed or neutered by 1 year of age. Bark-N-Buddies may request proof of spray or neuter. 5. HEALTH: Clients will certify their pet(s) have not been ill with a contagious condition in the last 30 days. For pets that have been ill in the last 30 days clients must provide documentation of health from their veterinarian to be admitted or re-admitted to Bark-N-Buddies. 6. VACCINES and FECALS: Bark-N-Buddies requires all pets to have current Rabies, DHPP and Bordatella vaccines, given by a veterinarian. Clients must provide proof required vaccines are current. Clients must also provide proof from a veterinarian of a negative fecal test every 6 months. If a vaccination is found to be expired, client will be notified and given 30 days to bring vaccination(s) current or we will be unable to care for your pet(s). Overdue vaccinations must be administered at least 72 hours prior to dog s stay at Bark-N-Buddies. 7. NAIL TRIM: If the length of dogs nails cause injury to another dog or staff, their nails will be trimmed at owners expense. 8. FLEA TREATMENT: We are a flea free environment. If your dog is not currently protected with a flea treatment and fleas are found during his/her stay, a flea treatment or flea bath will be applied and additional charges will be added to your account. 9. HOURS: We are closed New Year s Day, Independence Day, Thanksgiving Day and Christmas Day. DAYCARE: Monday-Friday hours are 6:30am-7pm. (5:30am drop off is available but MUST be pre-scheduled). Drop off times are 6:30am-10:00am and Noon-1:00pm. This is to allow quiet-time without disruption by new arrivals. Saturday and Sunday hours are 7am -7pm. No drop-offs or pick-ups between 11am-3pm. Late pickup maybe arranged, in advance, for a fee. Any dog(s) not picked up by 7:00pm, without advance notice, will be transferred to our boarding facility with current boarding and dinner fees applied to account. BOARDING: Boarding fees begin the day you drop off, regardless of the time. You are not charged for the day you pick up your dog(s) if you pick up by Noon. Drop off times are Monday - Friday 6:30am-10:00am, Noon-1:00pm, and 3:30pm-5:30pm; Saturday and Sunday 8:30am-11am and 3:00pm-5:30pm. Boarding dogs must be picked up between 8:30am and Noon on final day of stay. Any dog(s) picked up after Noon will be charged the current half-day daycare rate. Page 7

8 10. ALTERNATE AUTHORIZATION: Owner must provide written authorization to allow anyone other than themselves to pick up their pet(s). Authorized individuals will be required to present a valid picture id to ensure the safety of all animals. 11. RESERVATIONS: Reservations are strongly recommended for boarding and daycare to ensure space is available for your pet(s). 12. FEES (all rates and services subject to change without notice): Pet owner agrees to make complete payment at the time of check-out for services provided by Bark-N-Buddies. Evaluation: All dogs must pass an initial evaluation ($29.00 one-time fee) to join in group play or board. This is a minimum four- hour introduction day with our staff and dogs in the daycare. If Bark-N-Buddies observes or becomes aware of any unacceptable behaviors, as outlined in item #3, the dog may be prohibited from receiving any services. Late Pick-up: Late pickup may be arranged in advance for a fee. If daycare dogs are not picked up by 7:00 pm, without notice, they will be transferred to our boarding facility with boarding and dinner fees applied to client account. Cancellation: Cancellations must be made 24 hours prior to your pet(s) stay or a cancellation fee of $20.00 per dog will be applied. Salon: Salon fees are determined based upon weight. Estimates can be given by our receptionists. Transportation: In the event Bark-N-Buddies must transport your pet, for any reason, with or without notice to you, there will be a fee of $15.00 each way. Discount Passes: Bark-N-Buddies offers discounted daycare passes. Passes are valid for any pet(s) owned by the client and may be used for multiple pets on a single daycare visit. Discounted daycare passes are valid for ninety (90) days from the date of purchase. Passes are non-refundable. 13. FEEDING: You are welcome to bring your pets food and treats from home. If you choose to pay for meals, dog(s) will be provided our special blend of shredded organic chicken, rice, mixed vegetables, pumpkin and chicken broth. 14. PERSONAL ITEMS: You are welcome to bring personal items for overnight boarding, however Bark-N-Buddies is not responsible for loss or damage. Personal items are not allowed in daycare but we would be happy to put any such items in your dog s naptime kennel. 15. ABANDONMENT: I understand that if I fail to pick my dog(s) within fifteen days of notification to the provided phone and address, my dog(s) will be considered to be abandoned and will be handled in accordance with Washington State law. Doing so does not relieve me of my financial obligations. Bark-N-Buddies reserves the right to transfer any unpaid financial obligations to a collection agency. 16. NAME AND IMAGE USE: I consent that my name, myself, my dog and my family members and guests may appear on Bark-N-Buddies LLC website, advertising, printed materials, promotional videos, news programs and/or other press, magazine, radio, television and/or internet coverage from time to time. Page 8

9 Waiver, Medical Power of Attorney, Authorization and Acknowledgments I, the undersigned owner(s) of (dog(s) name), by means of this release, indemnify and forever hold harmless Bark-N-Buddies LLC, employees of, officers, investors, agents, subcontractors, volunteers, customers, visitors and guests from any and all liabilities (including attorney s fees) arising out of or connected with injuries, illness, loss, damage or other harm to myself, my dog, my property, and my guests and invitees which arise in any way out of services and/or products provided by or as a consequence of my association with Bark-N-Buddies LLC. I understand and acknowledge that dogs are unpredictable in behavior, and I understand and accept that injuries to my pet, myself, and my guests might reasonably be foreseen to result from my dog s attendance and participation with Bark-N-Buddies LLC, and its Subcontractors. I assume any and all risks related to Bark-N-Buddies LLC, and its subcontractors performance of its services, including but not limited to bites, bodily injury, illness and disease, theft, falls, collisions with vehicles, natural disasters and death. I agree to hold Bark-N-Buddies LLC harmless for conditions that are unavoidable during pet lodging or doggie daycare environments such as, but not limited to, weight loss, rough hair coat, kennel cough, upper respiratory infection, diarrhea, minor cuts and scratches. I also agree to assume all liabilities, costs, damages, claims and expenses that may occur as a result of my pet s actions. If I cannot be contacted, I authorize my emergency contacts to make necessary medical and financial decisions on my behalf regarding my dog(s). My emergency contacts are authorized to pick-up and transport my dog(s) to a veterinary care clinic. I authorize for emergency treatment of my dog(s) in the case that I or my emergency contacts are not available. Should the dog(s) identified on this record require care I authorize for emergency treatment of my dog(s) in the case that they become ill or suffer an ailment or is otherwise deemed by Bark-N-Buddies LLC, to require immediate medical attention. Bark-N-Buddies LLC, in its sole discretion, is authorized to make all health care decisions on my behalf, and may utilize the services of a licensed veterinarian of Bark-N-Buddies LLC, choice, to administer medicine or give other requisite attention to the pet at my sole expense. I authorize $ for emergency treatment of my pet(s) in the case that I or my emergency contact(s) are not available. If transportation is provided by Bark-N-Buddies LLC a fee will be charged to my account. I agree to pay all related expenses associated with the treatment of my dog(s) to the appropriate veterinary clinic. I hereby indemnify Bark-N-Buddies LLC, and subcontractors from any action, claim, demand or lawsuit (including attorney s fees) arising out of or connected with the charges made by any veterinarian caring for my dog. I specifically represent that I am the sole owner or agent of the owner of my pet, and that I am authorized to sign this contract. I will immediately notify Bark-N-Buddies LLC of any changes to what I have represented above. By signing below, I have read, understand and accept the terms outlined above in the Application and in the Policies and Procedures, and I accept exclusive and sole responsibility for these and all other risks and release Bark-N-Buddies LLC, and subcontractors of all liability, no matter the cause. I also acknowledge that all services, rates, policies and procedures are subject to change without notice. Page 9

10 I HAVE READ THE ABOVE AND I AM IN FULL AGREEMENT, AND CERTIFY THAT I AND MY PET(S) ARE IN COMPLIANCE, Signature of Client Date Name of Client Signature of Client Date Name of Client Office Use Only Enrollment package Proof of vaccination/fecal Database record Payment authorization Page 10

11 CREDIT CARD AUTHORIZATION I hereby authorize Bark-N-Buddies LLC to maintain my credit card number on file and charge purchases made, services rendered, emergency veterinarian care provided, cancellation/no-show, transportation or late fees against the card at the prices in effect at the time of the transaction if not paid within 30 days. All charges are final when made. This page will be secured in office safe to which only the owner has access. Name as it appears on card: My credit card is a: (circle one) Visa MasterCard Card number: Expiration Date: Security Code: Signature Print Name Date Page 11