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Transcript of · Web viewAre there other animals in your household? If yes, please list type, sex and age of...
Critter SittersDoggie Daycare & Boarding Enrollment Form
FOR OFFICE USE ONLYEnrollment Form Shots Staff ScreenedComputer Entry Folder First Day
NOTES:_________________________________________________________________________________________________
____________________________________________________________________________________________________
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EMERGENCY CONTACT INFORMATION
Owner Information
Name: _________________________________________________________________________________
Address:_______________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
E-Mail: _______________________________________________________________________________
Home Phone: ______________________________ Work Phone: ________________________
Cell Phone: _______________________________
Emergency Contact
Name: ________________________________________________________________________________
Home Phone: ______________________________ Work Phone: ________________________
Cell Phone: ________________________________
Pet Information
Name: ___________________________ Breed: _________________________ Sex: __________
Age: ________________________ Weight: ________________________
Veterinarian
Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
Phone: ________________________________________________________________________________Pet Personality Profile
General InformationHow did you hear about Critter Sitters? _________________________________________________________
Dog’s Name: ________________________________ Date you acquired dog: ____________________
Dog’s Breed, Sex, and Age: __________________________________________________________________
Is dog spayed/neutered? _______________________ If yes, at what age? _______________________
Where did you get your dog? __________________________________________________________________
If adopted, what knowledge do you have of your dogs past history? ___________________________________
Is your dog good with children, cats or other dogs? _________________________________________________
Are there other animals in your household? If yes, please list type, sex and age of each:
__________________________________________________________________________________________
Health/Grooming
Is your dog treated for fleas/ticks? ____________ Allergies or dietary restrictions? ________________
Is your dog treated with a heartworm preventative? ____________
Is your dog up to date on all shots/immunizations including Bortadella (kennel cough)? _____________________
Is your dog currently taking any medications or supplements? _____________ If yes, please list what for and the
dosing instructions: ___________________________________________________________________________
Does your dog have hip dysplasia? ____________ If yes, what restrictions need to be placed on your dog’s
Activities or movements? _______________________________________________________________________
Does your dog allow brushing? _______________________ Nail clipping? ______________________
BehaviorDoes your dog appear afraid of any specific items or noises? If yes, please explain:_______________________
_________________________________________________________________________________________
How does your dog react to strangers coming into your home or yard? _________________________________
__________________________________________________________________________________________
Does your dog ever bark or growl at anyone passing outside of your home or yard? ________________________
Are there any people your dog automatically fears or dislikes? If yes, please explain: ______________________
__________________________________________________________________________________________
Are there any dogs your dog automatically fears or dislikes? If yes, please explain.________________________
__________________________________________________________________________________________
How does your dog react to puppies? ____________________________________________________________
Has your dog ever:
Growled at someone? ________________ If yes, what were the circumstances? ________________
__________________________________________________________________________________
Bitten someone? ____________________ If yes, what were the circumstances? ________________
__________________________________________________________________________________
Does your dog have problems in any of the following areas? If yes, please explain:
Nipping/Mouthing: ___________________ Housetraining: ______________________________
Barking: ___________________________ Digging: ___________________________________
Jumping: __________________________ Other: _____________________________________
Has your dog ever growled or snapped at someone who has taken his/her food or toys away? If yes, what were the
Circumstances? ________________________________________________________________________________
Has your dog ever shared his/her food or toys with other animals? ______________________________________
Does your dog play with other dogs? ______________________________________________________________
Has your dog ever had formal obedience training? __________ If yes, when and where? _____________________
What commands does your dog know? ____________________________________________________________
Other comments about your dog you feel may be helpful: __________________________________________
Critter SittersOWNER AGREEMENT
I, _____________________________, hereby certify that my dog(s) ______________________________Is (are) in good health and has not been ill with any communicable condition in the last 30 days. I further certify that my dog(s) has not harmed or shown aggressive or threatening behavior toward any person or any other dog. I have read and understand the following:
1. I understand that I am solely responsible for any harm caused by my dog(s) while my dog(s) is attending Critter Sitters Dog Daycare Center (“Center”).
2. I further understand and agree that in admitting my dog(s) to the Center, Critter Sitters staff have relied on my representation that my dog(s) is in good health and have not harmed or shown aggressive or threatening behavior towards any person or other dog.
3. I further understand and agree that Critter Sitters and their staff, will not be liable for any problems which develop, 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 Center.
4. I further understand and agree that any problems which develop with my dog(s) will be treated as deemed best by the staff of Critter Sitters at their sole discretion, and that I assume full financial responsibility for any and all expenses involved.
I certify that I have read and understand the policies of the Center as set forth on the preceding pages and that I have read and understand the conditions, and statements of this agreements, including the following:
FEES: $30 per day, per dog for Doggie Daycare. $35 per day, per dog for boarding.
RESERVATIONS: Reservations and Appointments Required. Cancellations with less than 24 hours notice will be charged full fees.
Signature of Owner: ___________________________________
Date: _______________________________________________