The Dog Spot Guardian Profile
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- Jacob Day
- 7 years ago
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1 Guardian Profile Today s Date: Guardian Name: Dog s Name: Address: City: Zip Code: Home Phone Number: Business Phone Number Cell Phone Number: Address: Emergency Contact (Person not traveling with you) Name: Relationship Home Phone Number Business Phone Number Cell Phone Number Persons authorized to pick up my dog Names Veterinarian Name and Veterinary Clinic: Address: City: Phone Number ************************************************************************************** For Office Use Only Dog Profile Guardian Profile Vaccinations Evaluation Folder Made Owner Agreement Signed Computer Entry Bin Card Made First Day Temperament Physical Special Instructions **************************************************************************************
2 Dog Profile Guardian Name: General Information Dog s Name: Date of Birth: Breed: Color: Sex: Spayed/neutered? Weight: Date you acquired your dog: Where did you acquire your dog? If adopted, do you know about your dog s previous history? Do you have any other pets in your household? If so, please list species, sex and age of each: What kind of food and treats do you feed your dog? How much and how many times a day do you feed your dog? Is your dog on any medications or supplements? If so, what kind, for what ailment, and what is the dosage? Health and Grooming Information: Name of your dog s veterinarian: Date of your dog last veterinary exam: Reason for the exam: Please check any of the following medical conditions that apply to your dog: Hip dysplasia Skin condition (please explain) Food allergies Other allergies (please explain) Does you dog have any medical conditions that we should be aware of? If so, please explain Has your dog been ill with any communicable diseases in the past month? If so, please explain: Are there any restrictions (including exercise and food/treats) that should be placed for your dog s health? How does you dog respond to being brushed? How does your dog respond to nail trims? Is your dog sensitive to being touched anywhere? Where are your dog s favorite areas to be petted? How did you hear about The Dog Spot?
3 Dog Profile (continued) Guardian Name Behavioral Information: Is there a specific type of person that your dog reacts negatively to? If so, please explain Is there a specific type of dog that your dog reacts negatively to? If so, please explain Does your dog growl or try to bite when someone tries to remove his/her food or treats? Does your dog growl or bite when someone tries to remove a toy from him/her? Has your dog ever growled at or bit another person or dog. If so, please explain Is your dog house-trained? Is your dog crate trained? Where is your dog kept when left home alone? Where is your dog most comfortable during the day (inside/outside/crate/etc.)? Has your dog ever escaped from your yard? If so, please explain What kind of fence do you have and how high is it? Can your dog jump a 6 foot high fence? Does your dog eat rocks/gravel? Does your dog dig? Has your dog been socialized with large groups of dogs? Has your dog ever been socialized with puppies? Has your dog shared toys with other dogs? Does your dog play with toys? If so, what kinds? Has your dog received any formal obedience training? If so, when and where What commands does your dog know? Is there anything else you would like to tell us about your dog that you feel might be helpful?
4 Guardian Agreement I,, hereby certify that the information I have provided in regards to my dog,, is accurate and truthful. I further certify that my dog is in good health and has not been ill with any communicable condition in the past 30 days. I also certify that my dog has not harmed or shown any aggression toward any person or dog. I have read and understand the following: 1. I understand that my dog will be interacting with other dogs of different guardians, as well as with humans. I understand and agree that I am solely responsible for any harm caused by my dog, to humans or other dogs, while my dog is attending The Dog Spot LLC. 2. I understand and agree that The Dog Spot LLC, their staff, and volunteers will not be liable for any problems which arise, provided reasonable care and precautions are followed, and I hereby release them of any liability of any kind whatsoever arising from my dog s attendance and participation at The Dog Spot LLC. 3. I further understand, accept, and acknowledge the inherent and potential risk involved with interactions between humans and dogs, and dogs and other dogs, which may result in property damage or loss, and/or bodily injury, including but not limited to permanent disability, sickness, or death to human or dog. 4. I further understand and agree that by admitting my dogs to The Dog Spot, The Dog Spot LLC, their staff, and volunteers have relied on my representation that my dog has not harmed or shown any aggression towards any person or other dog, and that my dog is in good health. If either of these conditions change, I agree to disclose that information to The Dog Spot, and may not bring my dog back to The Dog Spot until the condition is resolved, as determined by The Dog Spot LLC. 5. I agree to keep my dog up-to-date on all vaccinations required by The Dog Spot LLC and to provide proof of all vaccinations to The Dog Spot. 6. I understand and agree that The Dog Spot LLC is not responsible for any lost, stolen, damaged, or destroyed items left with my dog. 7. I further understand and agree that any problems which develop with my dog will be treated as deemed best by The Dog Spot LLC, their staff, and volunteers, at their sole discretion, seeking veterinary treatment as deemed necessary, and I assume the full financial responsibility for any and all expenses involved. I also understand and agree that if my dog passes away while at The Dog Spot, the dog will be taken to a veterinarian, and I will be solely responsible for any costs that are incurred. 8. I give permission to The Dog Spot LLC to used any photographs, videos, and/or any likenesses of my dog to be used for for any purposes, anywhere, without compensation to me. 9. I further understand that if I neglect to pick up my dog from The Dog Spot on my scheduled pick up date, The Dog Spot LLC will, by default, become the legal owner and guardian after 7 days of no contact, instruction, or notification from me. I fully understand and agree that if I abandon my dog at The Dog Spot, I may be unable to retrieve possession of my dog, and have no recourse against The Dog Spot LLC, their staff, and their volunteers. Furthermore, I will be responsible for all expenses incurred during the dog s stay at The Dog Spot. Initials
5 Guardian Agreement (Continued) 10. I understand, accept, and agree that it is my responsibility to keep my dog s nails trimmed short to avoid injury to himself/herself and to other dogs. I understand that The Dog Spot LLC may trim my dog s nails at any time at my expense. Further, I understand, accept, and agree that it is my responsibility to keep my dog properly groomed and if the Dog Spot LLC finds it necessary to groom my dog, they may do so at my expense. 11. I understand and agree that my dog may be taken and kenneled off premises for health or behavioral reasons. 12. I understand and accept that my dog will be kenneled or crated at times while at The Dog Spot. 13. I understand, accept, and agree that The Dog Spot LLC may discipline my dog as required. 14. I understand, accept, and agree The Dog Spot LLC reserves the right to refuse service to any dog or guardian at any time for any reason. I certify that I have read and fully understand, accept, and agree with the policies of The Dog Spot LLC and that I have read and fully understand the conditions and statements of this agreement, including the following: *Fees are due at the time of intake. If I am late, I will be charged $1.00 per minute after 6:30pm on Mondays through Saturdays and 6:00pm on Sundays. If, after 15 minutes, I have still not arrived, my dog will be kept overnight in The Dog Spot boarding facility and I will be charged boarding fees, along with the previous daycare fees, the following day, upon pick up of my dog. If I would like to extend my dog s stay while my dog is being boarded, I will call at least 24 hours in advance and I will not be charged above the boarding rate as long as The Dog Spot is not booked. *Hours of operation are Monday through Saturday from 6:30 am to 6:30 pm, but closed daily from 12:00pm to 2:00pm. We are also open Sundays from 7:00am to 10:00am and 3:00pm to 6:00pm. *Daycare reservations must be cancelled at least 24 hours in advanced, or I will be charged the full amount of my reservation. *Boarding reservations must be cancelled one week (7 days) in advance, or I may be charged the full amount of my reservation. *The Dog Spot LLC accepts cash, checks, MasterCard, Visa, and Discover cards. A $25 fee will be charged for all returned checks. Signature of Guardian Name Date Initials
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