BARK-N-BUDDIES DOGGIE DAYCARE, LLC. Owners Name Date. Address: City: State: Zip: Home Phone Work Phone Work Phone. Cell Cell .

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Caroline Jenkins
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Owners Name Date Address: City: State: Zip: Home Phone Work Phone Work Phone Cell Cell E-mail E-mail Emergency Contact Phone Emergency Contact Phone Veternarian Clinic Address Phone Pet s

1 Owners Name Date Address: City: State: Zip: Home Phone Work Phone Work Phone Cell Cell Emergency Contact Phone Emergency Contact Phone Veternarian Clinic Address Phone Pet s information: Dog's Name Breed Color Sex Spay or Neutered Age Birthdate Dog's Name Breed Color Sex Spay or Neutered Age Birthdate Dog's Name Breed Color Sex Spay or Neutered Age Birthdate If adopted or rescued do you have knowledge of your dog's history? Page 1

2 Describe Dog's condition at time of adoption/ rescue How long has dog been with you? Veterinarian Phone HEALTH INFORMATION: Owner s 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? Yes or No, if Yes Please list instructions for giving medication, allergies and sensitivities. Does your dog have any physical limitations such as hip dysphasia? Yes or No, if Yes what restrictions should be placed on your dogs activities/ movements. GROOMING: Does your dog like to be brushed/ combed? (Yes or No) Does your dog have any sensitive areas on their body? (Yes or No) if Yes explain Page 2

3 Where are your dog s favorite petting/ scratching spots? (Yes or No) if Yes explain How does your dog react to nail trimming? (Yes or No) if Yes explain How often and what flea product do you use on your dog? BEHAVIOR: Has your dog been to Daycare before? (Yes or No) If Yes where Describe dog s behavior around children? Are there other pets in your household? (Yes or No) 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) if Yes, Page 3

4 Describe how your dog reacts to visitors entering your home or yard? Does your dog bark or growl at anyone passing by your home or yard area? Describe the type of people your dog automatically fears or dislikes? How does your dog react to puppies? Has your dog ever bitten anyone, human or animal? (Yes or No) if Yes, describe Does your dog have any problems in the following areas? Mouth/Bark/Jump/House Trained/Digging and others explain Page 4

5 Has your dog ever been in crate Had Obedience Training if so, what Commands does your dog know? Has your dog growled or snapped at anyone near their food or toys? (Yes or No) if Yes explain Is your dog nervous, aggressive, fearful, calm, standoffish, playful, and shy, frighten easily, come to name, ignores commands, shares toys. (Circle any that apply) Is there training you would like us to reinforce with your dog? What comments about your dogs that might be helpful to our staff? How did you hear about Bark N Buddies Doggie Daycare? Page 5

6 Statement of Policies 1. AGE: All pets must be at least 16 weeks of age or older. 2. SEX: All dogs joining in our daycare must be spayed or neutered. 3. VACCINES and FECALS: All pets must have up to date vaccines given by a veterinarian. Any overdue vaccines must be updated at least 7 days before checking into our facility. Clients must provide proof of current required vaccines: a. Dogs- Rabies, DHPP, Lepto and Bordatella. A negative Fecal test every 6 months is also required for our daycare guests. 4. 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, flea treatment will be applied. Additional charges will be added to your account. 5. FEEDING: We are currently serving veterinarian recommended diet pet food. You are welcome to bring your pet s food and treats from home. We do not accept any raw food diets or treats. 6. PERSONAL ITEMS: You are welcome to bring personal items, however Bark-N-Buddies cannot be responsible for loss or damage. Personal items are not allowed in daycare, we would be happy to put any of these items in your dog s naptime kennel. 7. 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. 8. BEHAVIOR: Clients must inform Bark-N-Buddies staff of their pet s behaviors. All daycare dogs must be non-aggressive with humans, other dogs or around toys or food. Daycare clients will certify that their dog(s) have not harmed, shown aggression, or shown threatening behavior towards any person or dog. 9. AGREEMENT: All pets must have a complete, up to date and approved agreement on file. 10. FEES: Boarding timers run on a 24 hour clock, they are started at check in and stopped at check out. Doggy Daycare guests must pass an initial evaluation to join in group play. This is a four hour introduction day with our staff and dogs in the daycare. We also offer discounted daycare passes. Please inquire with our receptionists for current boarding and Doggy Daycare rates. Pet Salon fees are determined upon the size of each animal. Estimates can be given by our receptionists. 11. HOURS: General hours are 5 days a week, 6:30-10:00am and 12:00-12:30pm with the last drop off/pick up by 5:30-6:30pm. Daycare hours are Monday-Friday 6:30am-7pm. If daycare dogs are not picked up by 7:15pm they will be transferred to our boarding facility and charged accordingly to your account. We are closed New Year s day Independence Day, Thanksgiving day and Christmas day. 12. RESERVATIONS: Clients are recommended to make reservations for the boarding and daycare to ensure space is available for their pet(s). Page 6

7 Bark-N-Buddies cannot guarantee the health of any pet, but pledges to give appropriate care to all guests. By signing this form I hold Bark-N-Buddies harmless for conditions that are unavoidable during pet lodging or doggy daycare environments such as, but not limited to, weight loss, rough hair coat, kennel cough, upper respiratory infection, diarrhea, minor cuts and scratches, etc. I authorize $ for emergency treatment of my pet(s) in the case that I or my emergency contacts are not available. If I cannot be contacted, I authorize my emergency contacts to make necessary medical and financial decisions on my behalf regarding my pet(s). Should the pet(s) identified on this record require care, my emergency contacts are authorized to pick-up and transport my pet(s) to a veterinary care clinic. If my emergency contacts are unavailable, I authorize Bark-N-Buddies staff to transport my pet(s) to my family veterinarian or nearest animal emergency clinic. If transportation is provided by Bark-N-Buddies a fee will be charged to my account. I agree to pay all related expenses associated with the treatment of my pet(s) to the appropriate veterinary clinic. I agree to make complete payment to Bark-N-Buddies for services provided at the time of check-out. I certify that my pet(s) appear(s) to be free of contagious disease and has/have not bitten anyone within the past ten days. I understand that if I fail to pick up my pet(s) within fifteen days of notification to the above address, my pet(s) will be considered to be abandoned and will be handled in accordance with Washington State Law, and doing so does not relieve me of my financial obligations. I HAVE READ THE ABOVE AND I AM IN FULL AGREEMENT, Signature of Client Date Office Use Only Enrollment Shots Screened In Computer Pmt Record Auth. P/U Page 7

Emergency Contact Information

Emergency Contact Information Owner Information Name: Address: City: Home phone: Work Phone: Email: Is it ok to send pictures/updates to this email? Y-N Cell Phone: Emergency Contact Other than yourself