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1 Complete Canine Care OWNER INFORMATION Title Forename & Surname Home address Work address Home Phone Work Phone Mobile Phone PARTNER/SPOUSE Name Work Phone Mobile Phone How did you hear about us? Word of mouth Website Flyer Google Other EMERGENCY CONTACT/ PICK UP (If urgent pick up during the day is require and you are not available) Name Work Phone Mobile Phone DOG BASIC INFORMATION Dog 1: Name Breed Sex (M/F) Age D.O.B Desexed \ Colour Registration number Microchip number Complete Canine Care Application Page 1
2 Dog 2: Name Breed Sex (M/F) Age D.O.B Desexed Colour Registration number Microchip number VETERINARIAN INFORMATION VETERINARIAN INFORMATION Vet Practice Telephone Number Address DOG MEDICAL AND HEALTH Date received Date Due Kennel cough 5 in 1 (DHPPV, distemper, parvo etc) Lepto Virus Date received Date last dose given Date Due Medication used Flea/ Flea/Worm treatment Date last dose given Medication used Any medical condition or injuries? Any allergies/food sensitivity? Any restriction of movement? e.g. dysplasia, arthritis Complete Canine Care Application Page 2
3 DOG BEHAVIOUR Is your dog anxious or frightened by any of the following: Noises People Other dogs Cars Objects Has your dog ever Reacted negatively around food Growled at someone Bitten someone Shown aggression to other dogs If you have answered yes to any of the above questions please give details: SOCIALISATION Does your dog enjoy playing with other dogs? Does your dog willingly share toys with other dogs? Any type of dog your dog automatically dislikes? What games does your dog enjoy? (chase, ball etc) How often does your dog socialise? How does your dog react to other dogs on the lead? How does your dog react to dogs off the lead? Does your dog willingly share food and toys? Are you happy with treats at day care/ on walks? Yes No TRAINING Has your dog attended formal training? Please Specify What commands does your dog know? Sit Stay Heal Come Off Leave Down Wait Please specify if you use different words for certain commands Complete Canine Care Application Page 3
4 COMPLETE CANINE CARE SERVICES Please indicate service, frequency and preferred time and days. Day Care Frequency(how many times a week) Half or full day Kennels Frequency(how many times a week) School bus (pickup/drop off) Frequency(how many times a week) Pick up, drop off or both Grooming Please indicate the frequency that suits you best Full Groom Wash/Dry Nails Only One-on-one Dog walks Frequency(how many times a week) Time(Morning, Midday, Afternoon) Group Dog walks (Waiatarua Reserve) Frequency(how many times a week) Time(Morning, Midday, Afternoon) EVALUATION SESSIONS All evaluation session are conducted between 7:00am-7:45am on a chosen week day. We will be in contact shortly to book in a day that suits you. Depending on the evaluation, your dog will either stay on for a full day or half day. Complete Canine Care Application Page 4
5 TERMS AND CONDITIONS I (the owner) hereby declare to Complete Canine Care that I am the legal owner of my dog; that my dog has not been exposed to distemper, rabies or parvo within the past thirty days; that my dog has been inoculated as indicated by records present; that my dog is currently and properly licensed. I understand that Complete Canine Care s Day Centre is a cage-free facility. I accept the risks involved and agree that Complete Canine Care is not liable for any injuries or illness resulting during my dog s attendance. I understand that Complete Canine Care take the utmost caution in order to keep my dog safe. I accept the risks of off leash exercise and agree that Complete Canine Care is not liable for any injuries or illnesses resulting during either on lead or off lead dog walks provided by Complete Canine Care. I understand that I am liable for any medical care expenses and damages that result from injuries caused by my dog. I understand that if my dog has a history of aggression or biting, Complete Canine Care reserves the right to refuse service for my dog and have disclosed to Complete Canine Care all known danger associated with my dog. I expressively waive and relinquish any and all claims against Complete Canine Care, its employees and representatives, except those arising from negligence on the part of Complete Canine Care I understand that under no circumstances will Complete Canine Care be liable for consequential damages or damages beyond the replacement value of my dog. If any medical problems develop while my dog is in the care of Complete Canine Care, I authorise Complete Canine Care to do whatever they deem necessary for the safety, health and wellbeing of my dog and I agree to assume full financial responsibility for any and all expenses incurred I understand that Complete Canine Care have the right to refuse service to me and my dog at any time and for any reason. In addition to the terms and conditions set out in this agreement I confirm that I have read and understood the rules and regulations outlined on Complete Canine Care s website PAYMENT REQUIREMENTS I understand that I must pay Complete Canine Care in advance for any service being provided apart from grooming I understand that I must allow at least 24 hours for notice of cancelation or change in schedule day/time and that I will be charge 100% for no shows. I understand that the hours of operation are 7:00am-6:30pm for all services except the kennels which are open until 7pm. A late $10 fee applies and another $10 for every 15minues thereafter. If I have not picked my dog up by 7:30pm, Complete Canine Care will make arrangements for overnight boarding at my expense. If I purchase a half day service and fail to pick my dog up by 1pm, I will be charged the full day rate. I have read all the above and agree Signature Date OFFICE USE Date Staff Play Group Database no. Complete Canine Care Application Page 5
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