Page 1

DOG DAYCARE APPLICATION How did you hear about us (circle all that apply):

Sign

Web

Print Ad

Referral

Who referred you?

OWNER INFORMATION Name Street Address City

State

Zip

Cell/Primary Phone

Secondary Phone (if applicable)

Work Phone (if applicable)

Email Address

EMERGENCY INFORMATION

Name

Primary Phone DOG INFORMATION

DOG #1 Name Age

Female Male (circle one) Birthdate (if known)

Weight

Micro Chip:

Spayed/Neutered: YES NO (circle one)

Breed YES

Color

NO (circle one) Company Name/Phone

Where did you get this dog?

How long have you had him/her?

Any info on prior history? Medical Information Does your dog have allergies?

YES

NO

Is your dog on monthly flea/tick program?

YES

NO

Is your dog on any medications?

YES

NO

If yes, to what?

If yes, what?

Special medical instructions/restrictions? Feeding Schedule Brand/Type of Food Allowed to have treats?

YES

NO

If yes, what type?

Does your dog growl or become aggressive around food/treats/toys? What other pets do you have?

YES

NO


DOG DAYCARE APPLICATION How do your dog interact with other dogs and/or children in the home?

How does your dog react to visitors in the home? Does your dog has specific fears of certain people, things, etc. (certain types of other dogs, gender of people, clothing, hats, etc.)? Has your dog ever growled, snapped or bitten a person or another dog? Please explain.

What other exercise does your dog receive (walking, etc.)? Is your dog housebroken or crate trained? Has your dog ever been to daycare before?

YES

NO

Has your dog received any formal training?

YES

NO

Aggression

YES

NO

Excessive Barking

YES

NO

Separation Anxiety

YES

NO

Possessive

YES

NO

Afraid of noises

YES

NO

Chews

YES

NO

Digs

YES

NO

Jumps

YES

NO

Eats stool

YES

NO

Shy

YES

NO

Does your dog have any of the following issues?

Please provide any other additional information that you think is relevant in the proper care of your dog:


DOG DAYCARE APPLICATION DOG #2 Name Age

Female Male (circle one) Birthdate (if known)

Weight

Micro Chip:

Spayed/Neutered: YES NO (circle one)

Breed YES

Color

NO (circle one) Company Name/Phone

Where did you get this dog?

How long have you had him/her?

Any info on prior history? Medical Information Does your dog have allergies?

YES

NO

Is your dog on monthly flea/tick program?

YES

NO

Is your dog on any medications?

YES

NO

If yes, to what?

If yes, what?

Special medical instructions/restrictions? Feeding Schedule Brand/Type of Food Allowed to have treats?

YES

NO

If yes, what type?

Does your dog growl or become aggressive around food/treats/toys?

YES

NO

What other pets do you have? How do your dog interact with other dogs and/or children in the home?

How does your dog react to visitors in the home? Does your dog has specific fears of certain people, things, etc. (certain types of other dogs, gender of people, clothing, hats, etc.)? Has your dog ever growled, snapped or bitten a person or another dog? Please explain.

What other exercise does your dog receive (walking, etc.)? Is your dog housebroken or crate trained? Has your dog ever been to daycare before?

YES

NO

Has your dog received any formal training?

YES

NO

YES

NO

Does your dog have any of the following issues? Aggression


DOG DAYCARE APPLICATION Excessive Barking

YES

NO

Separation Anxiety

YES

NO

Possessive

YES

NO

Afraid of noises

YES

NO

Chews

YES

NO

Digs

YES

NO

Jumps

YES

NO

Eats stool

YES

NO

Shy

YES

NO

Please provide any other additional information that you think is relevant in the proper care of your dog:


DOG DAYCARE APPLICATION DOG CARE AGREEMENT I understand that Paws on Pearl, LLC has relied upon my representation that my dog is in good health and has not injured or shown aggression or threatening behavior to any person or dog in admitting my dog for services at their facility. I further understand that Paws on Pearl, LLC, their owners, staff, partners and volunteers will not be held liable, financially or otherwise, for injuries to my dog, myself or my property while my dog is participating in services provided by Paws on Pearl, LLC . I hereby release Paws on Pearl, LLC of any liability of any kind arising from my dog’s participation in any and all services provided by Paws on Pearl, LLC. I further understand and agree that any problems with my dog, behavioral, medical or otherwise will be treated as deemed best by staff of Paws on Pearl, LLC in their sole discretion and in what they view as in the best interest of the animal. I understand that I assume full financial responsibility and all liability for any and all expenses involved in regards to the behavior and health of my dog. I further understand that there are risks and benefits associated with group socialization of dogs. I agree that the benefits outweigh the risks and that I accept the risk. I desire a socialized environment for my dog while attending services provided by Paws on Pearl, LLC and while in their care. I understand that while the socialization and play is closely and carefully monitored by Paws on Pearl LLC staff to prevent injury, it is still possible that during the course of normal play that my dog may receive minor nicks and scratches from roughhousing with other dogs. Any injuries to my dog will be pointed out by staff upon pick-up. I understand that by allowing my dog to participate in services offered by Paws on Pearl, LLC I hereby agree to allow Paws on Pearl, LLC to take photographs and/or use images of my pet in print or digital form or otherwise for publication and/or promotion. I further understand that I am solely responsible, financially or otherwise, for any harm or damage caused by my dog while my dog is attending any services provided by Paws on Pearl, LLC. Payment is required when services are rendered. If Paws on Pearl pursues collection proceedings, I will pay reasonable attorney’s fees and costs of collection above and beyond the debt owed.

I have received, read understood and agreed to the terms outlined in this document. Owner’s Signature Print Owner’s Name Dog Name

Date

Pop daycare application  
Advertisement