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K9 to 5 Dog Daycare Application and Waiver Forms These Forms Must Be Filled out in Full, Dated, Signed, and Approved by the Daycare Prior to Your Dog’S First Booking

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K9 to 5 Dog Daycare Application and Waiver Forms These Forms Must Be Filled out in Full, Dated, Signed, and Approved by the Daycare Prior to Your Dog’S First Booking K9 to 5 Dog Daycare Application and Waiver Forms These forms must be filled out in full, dated, signed, and approved by the daycare prior to your dog’s first booking. Date: ______________________ Approved by: ________________________ Dog Information: Dog’s Name: _______________________ Breed: ____________________ Colours: _______________________ City License #: ____________________ Birthdate (year): ____________________ Microchip #: ____________________ Sex: Male [ ] Female [ ] Tattoo: ____________________ (all dogs over 6 months must be spayed or neutered) Owner Information: Owner Name(s): _______________________________________________________ Address: _____________________________________________________________ City: ____________________________ Postal Code: _______________________ Home Phone: ____________________ Work Phone: ______________________ Cell Phone: ______________________ Email: ____________________________ Authorised Persons and Businesses: The following are the names of individuals and businesses that have your permission to pick up your dog from K9 to 5 Dog Daycare. You understand that once dogs are released into the care of authorised persons or individuals that K9 to 5 Dog Daycare and K9 High Dog Training Inc are no longer responsible for the well-being of your pet. Authorised Individuals: Authorised Businesses (check all that apply): Name: __________________________ Urban Tails Dog Walking [ ] Name: __________________________ Atomic Dog [ ] Name: __________________________ Other (please specify) ______________________ Other (please specify) ______________________ Other (please specify) ______________________ Emergency Information: Emergency Contact Name: ___________________ Phone: (h)__________(w)__________(c)__________ Primary Veterinary Clinic: ____________________ Clinic Address: _______________________________ Preferred Veterinarian if any: _________________ Clinic Phone: ________________________________ Copy of up to date vaccinations attached? Rabies [ ] DHLPP [ ] Bordetella [ ] *Please note that bordetella is not a regular booster and is reserved for dogs that are being boarded or are attending daycare. You will need to request this vaccine from your vet specifically in addition to your regular boosters. 1/3 Care Is your dog being fed at daycare? Yes [ ] No [ ] If yes, please specify the time and amount of food. You are responsible for supplying your dog’s food: __________________________________________________________________________________ Medications: ________________________________________________________________________ Allergies: ________________________________________________________________________ Physical limitations or health problems: ___________________________________________________ *Please note, if your dog has been ill with a communicable or potentially communicable disease within the past 30 days a health clearance signed by a licensed veterinarian must be received before your dog can attend daycare. Please do not bring ill (vomiting, diarrhea, eye/ear infections) or injured (sore, limping etc) dogs to daycare. Pet Behaviour Profile: How long have you owned your dog? ______________ Where did you get your dog? ________________ Has your dog been to a daycare before? Yes [ ] No [ ] Is your dog comfortable with strangers? Yes [ ] No [ ] Does your dog get along well with larger dogs? Yes [ ] No [ ] Does your dog get along well with smaller dogs? Yes [ ] No [ ] Does your dog get along well with puppies? Yes [ ] No [ ] If you answered ‘no’ to any of the last four (4) questions please describe: _______________________________ ____________________________________________________________________________________________ Does your dog prefer male or female playmates? Male [ ] Female [ ] Either [ ] Is your dog sensitive to touch on any part of their body? _____________________________________________ Has your dog had any formal obedience training?: Yes [ ] No [ ] If yes, what type, where and when? _____________________________________________________________ Potty command? : __________________________________________________ Release word?: __________________________________________________ If your dog has any special commands you would like used, write them here:___________________________ ___________________________________________________________________________________________ Has your dog ever…? (If yes, please describe) Growled at someone: ______________________________________________________________________ Bitten or snapped at a person: _______________________________________________________________ Reacted negatively when food or toys are taken: ________________________________________________ Been in a fight with another dog: _____________________________________________________________ Does your dog have any problems in the following areas? Check all that apply. Mouthiness on hands or clothing [ ] Coprophagia (feces eating) [ ] Housetraining [ ] Destructive chewing [ ] Excessive Barking [ ] Separation Anxiety [ ] Fence Jumping [ ] Jumping Up [ ] Digging [ ] 2/3 Daycare Rules and regulations: We accept dogs of all ages. Puppies must be over 10 weeks and on a vaccination program. Puppies or shelter dogs must have been in the home for at least two weeks prior to attending daycare. All dogs over the age of 6 months must be spayed or neutered All dogs require up to date vaccinations for rabies, DHLPP, and bordetella. Proof of vaccination or titer testing is required. Dogs that are currently ill or injured are not permitted at daycare. Dogs who have recovered from a communicable illness within the past 30 days must provide veterinary clearance to return to daycare. Owners certify by signing this application that their dog is in good health. If your dog incurs veterinary bills during their stay at daycare you, the legal owner of the animal, must pay those bills at time of pickup. K9 to 5 Dog Daycare reserves the right to seek veterinary care for your dog at its discretion. All dogs must be non-aggressive and not food or toy possessive. Owners certify by signing this application that their dog has no history of threatening or harming any person or animal. Due to restrictions in place by our insurance company, K9 to 5 Dog Daycare may not be able to accept certain breeds or types of dog. We reserve the right to refuse any dog for any reason at any time. Pick-ups must be completed by 6:00 PM. Late fees for late pick-ups do apply at a rate of $15.00 for every 15 minutes past 6:00 PM. No exceptions. Daycare passes have no cash value and are non-refundable. No exceptions. Waiver of Liability I, the undersigned, am satisfied that K9 to 5 Dog Daycare and K9High Dog Training Inc. is maintained for the health, comfort, and protection of my animal(s). I am the owner/agent of the above named animal(s) and will not hold K9 to 5 Dog Daycare and/or K9High Dog Training Inc. owner or staff responsible for any accident or injury or loss or death of my animal on or off the premises at 4618 Bowness Road NW, Calgary, Alberta unless caused by gross negligence by the owner or staff of said company. I further understand that due to the way dogs interact with one another, minor cuts, scratches, and other injuries can occur even though the dogs are carefully supervised. While my animal(s) is/are in the care and custody of K9 to 5 Dog Daycare and K9High Dog Training Inc., if I am unreachable in the event of an emergency, I hereby authorize K9 to 5 Dog Daycare and K9High Dog Training Inc., its agents, and/or representatives to seek immediate veterinary care for my animal(s). I understand that all costs in connection with veterinary or medical treatment shall be my responsibility. I certify that my animal(s) is/are in good health and have not harmed or shown any aggressive or threatening behaviour towards any person or any other dog. I agree to pay the cost of training and/or daycare services for my animal(s). I also agree to be financially responsible for undue personal or property damage caused by my animal(s). If any claim is made against K9 to 5 Dog Daycare and/or K9High Dog Training Inc. owner or staff by reason of any act of my animal(s), I agree to indemnify, hold harmless, and defend K9 to 5 Dog Daycare and K9High Dog Training Inc. against such a claim. I certify that I have read and understand the rules and regulations herein and that I have read and understand this this agreement. I agree to abide by the rules and regulations and accept all terms, conditions, and statements of this agreement and confirm the truthfulness of the contents of the application form completed by me. I am of the full age of eighteen years of age. Date: _____________________________ Signature: ___________________________________ 3/3 .
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