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The Dog's Park
The Dog's Garage
Wednesday,February 22,2012
Daycare Application
Location (*)
Dog's Park
Dog's Garage
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DOGGIE INFORMATION
Dog's Name (*)
Please let us know your name.
Breed or Mix (*)
Please write a subject for your message.
Coat Colour (*)
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Age / DOB (*)
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Sex (*)
Male
Female
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Spayed/Neutered (*)
Yes
No
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Micro-chipped/Tattoo
Micro-chipped
Tattoo
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CLIENT INFORMATION
First Name (*)
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Last Name (*)
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Address (*)
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Phone # (*)
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Alternate #
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Email Address
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Special Instructions for Contacts
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WHO IS AUTHORIZED TO PICK UP YOUR DOG?
Name 1 (*)
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Name 2
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VETERINARIAN INFORMATION
Name of Clinic (*)
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Veterinarian's Name
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Address
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Vontact Number
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Shot Record (date administered)
DHLLP
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BORDETELLA
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RABIES
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Flea/Tick Control
ADVANTAGE
REVOLUTION
SENTINEL
OTHER
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(Check brand name of product used. Dogs must be protected seasonally in order to participate at Doggie Central Ltd.)
Is your dog on any type of medication? (*)
Yes
No
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If yes please describe
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Does your dog have any sensitive areas on his/her body? (*)
Yes
No
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If yes please describe
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What brand of food are you feeding your dog?
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IMPORTANT: Please bring written documentation of all of your dog’s vaccinations and flea prevention program to the assessment review. Please note that many veterinarians administer the Bordatella vaccination only by request
DOGGIE PROFILE
How long have you had your dog?
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Where did you get your dog?
Breeder
Pet Store
Other
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If adopted, do you have knowledge of your dog’s past history?
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SOCIAL BEHAVIOUR
Does your dog respond to the following commands? (please check all applicable) (*)
Sit
Stay
Down
Come
Off
Drop it
Quiet
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Please list any other commands your dog responds to.
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When introduced to a new dog, is your dog; (please check all applicable) (*)
Friendly
Confident
Stand offish
Pushy
Aggressive
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Has your dog ever bitten another dog? (*)
Yes
No
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If yes please explain the circumstances.
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Has your dog ever bitten a person? (*)
Yes
No
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If yes please explain the circumstances.
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Has you dog shown aggression towards any of the following;
Food
Toys
Loud noises
Quick movements
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LIFESTYLE
Number of adults in your household (*)
1
2
3
4
5
6
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Number of children in your household
None
1
2
3
4
5
6
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Please indicate how many and the type of other animals in your household
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Is your dog house trained? (*)
Yes
No
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Is your dog crate trained? (*)
Yes
No
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Does your dog walk off leash (*)
Yes
No
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Does your dog have free run in your home? (*)
Yes
No
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Is your dog allowed on furniture? (*)
YES
NO
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Where does your dog typically sleep? (*)
Own Bed
Crate
Our/my bed
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OTHER INFORMATION
Is there anything else we should know about your dog?
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Contract, Release and Agreement (*)
DOGGIE CENTRAL LTD. THE DOG’S GARAGE LTD. CONTRACT, RELEASE AND AGREEMENT DAYCARE RELEASE OF LIABILITY AGREEMENT, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT BY AGREEING TO THE TERMS OF THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE PLEASE READ CAREFULLY! The Doggie Central Ltd. and The Dog’s Garage Ltd. agrees to exercise due diligence and reasonable care, and to keep the premises sanitary and properly enclosed. All dogs are handled or cared for by the DAs (Dog Assistants) without liability on Doggie Central Limited or The Dog’s Garage Limited’s part for loss or damage from disease, theft, fire, death, escape, injury, or harm to person's, other dog(s) or property by said dog, or from other unavoidable causes, due diligence and care having been exercised. Should any dog(s) become ill or seem to be in need of medical attention, Doggie Central Ltd. and/or The Dog’s Garage Ltd. reserves the right to administer aid and/or to use any available veterinarian. All expenses so incurred shall be paid by the owner of said dog in addition to any other applicable fees. Owner agrees to pay the rate for service in effect, on the date and time the dog is checked into Doggie Central or The Dog’s Garage. Prices are subject to change without notice. Late cancellation fees will be applied for reservations cancelled after 5:00pm on the previous day of the scheduled reservation. Late pick up fees will be applied for pick up after 6:00 pm on the day of the scheduled reservation at a rate of 0.50 cents per minute for the first 15 minutes and $1.00 per minute all minutes thereafter. Should my dog not be picked up at the specified time I authorize Doggie Central Ltd or The Dog’s Garage Ltd. to take whatever action deemed necessary for the continuing care of my dog and I will pay all costs and charges thereof. Owner shall remain liable for all daycare bills and other applicable charges accrued in the care and maintenance of the dog listed in this contract. The Owner further agrees to be solely responsible for any and all acts or behaviour of said dog while in the care of Doggie Central or The Dog’s Garage. The Owner of the pet agrees to pay any and all attorney fees incurred by Doggie Central Ltd. and/or The Dog’s Garage Ltd. in the collections of any daycare services, training fees, or other charges accrued by the Owner of the dog. Owner shall report any and all incidents of aggression before dog is dropped off for daycare. The dog must have at least two sets of shots before entering the daycare. Valid proof of vaccinations must be present before pet can be dropped off for daycare. Owner also agrees to maintain vaccinations and to keep Doggie Central and/or The Dog’s Garage DA (Dog Assistants) staff up to date on any changes. Pets arriving with fleas / ticks will not be accepted. Sick and/or injured dogs will not be accepted into unless previous arrangements have been made. Doggie Central Ltd. and/or The Dog’s Garage Ltd. reserves the right to refuse any dog for any reason. Owner agrees that the dog will be picked up by the owner or other pre-approved person by 6:00 pm weekdays, unless a prior extension is agreed to prior to dropping the pet off for daycare. Late charges will be executed at the manager's discretion as per above. There is a strict NO REFUND POLICY once payment has been received by the daycare, this includes pre-paid daycare packages. Pre-paid daycare packages are NOT TRANSFERABLE. My dog may be videotaped, photographed and recorded when on Doggie Central and/or The Dog’s Garage premises and Doggie Central Ltd. and/or The Dog’s Garage Ltd. shall be the exclusive owner to the results and proceeds of such taping, photography and recordings with the rights, throughout the world, of unlimited use, and to copyright, to use and license in any manner. Declaration Dogs are animals and as such can be unpredictable and have the potential of displaying unwanted behaviours without warning. Working with dogs is not without risk to students, family members, guests, other people, dogs and possessions. Assumption of Risk The undersigned hereby agrees to indemnity, agree to hold harmless, and to release from liability; Doggie Central Ltd. and/or The Dog’s Garage Ltd., and/or its principals along with all other related names and combination of names, employees and agents for any and all risks involved with any and all products and/or services of the facility, and any and all direct or indirect results thereafter. Indemnity The undersigned hereby agrees to indemnity, agree to hold harmless, and to release from liability; for any claim by any person or company against Doggie Central Ltd. and/or The Dog’s Garage Ltd., and/or its principals along with all other related names and combination of names, employees and agents including the legal costs to defend any such claim, whether or not the damages are caused in whole or in part by the negligence, actions or inaction's of any of these parties. Release from Liability In consideration of the care of my animal, I hereby agree to waive any and all claims I have or in the future may have as against, Doggie Central Ltd., The Dog’s Garage Ltd., their affiliates, and their respective, directors, officers, employees, agents, representatives, successors and assigns (all of whom are hereinafter collectively referred to as “THE RELEASEES”), and TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury that I may suffer, or that my next of kin may suffer resulting from my presence on the Facilities, DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS’ LIABILITY ACT AND DOG OWNERS’ LIABILITY ACT , ON THE PART OF THE RELEASEES, Aggression I certify that my dog (s) has not shown aggression or threatening behaviour towards any person, other dogs, toys, or food. I will abide by the rules and regulations of Doggie Central Ltd. and The Dog’s Garage provided to me and/or posted from time to time at either of the premises. Signing below indicates your acknowledgment, understanding and agreement to all of the terms contained within this Contract, Agreement and Release, and that you are setting your hand hereto delivering your signature freely, voluntarily and unconditionally.
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Today's Date (*)
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I Agree (*)
I agree to the Contract Release and Agreement
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