COUNTRY CANINE CARE (a division of GREEN ACRES HOBBY FARM LTD)
ENROLLMENT AND LIABILITY WAIVER
Dog daycare and/or boarding
Please fill out, sign and date the Country Canine Care Plan as well as completing this form with date and signature. Thank you.
Dog’s name: ______Male___ Female ___ Spayed/neutered: Yes ___ No ___
Dog’s identification Tattoo ______Microchip ______
Owner’s information:
Name: ______
Contact number(s) Cell ______Home______Work______ext______
Address: ______
Email: ______
Emergency contact information (someone who is available for emergency pick up in your absence):
Name: ______
Contact number(s) Cell ______Home______Work______ext______
Please circle where an option is presented and initial that you have read and understood each section. Thank you.
1) Veterinarian: ______Phone______
Please provide proof of the following: DA2P, Bordetella, Rabies and flea control. Parasite (deworming) is recommended. Initial: ______
Medications/or none: ______Initial:______
Please note, oral medication may be administered during your dog’s day/stay, however, due to our insurance policy requirements and in the interest of safety, the medication must be in its original packaging from the Veterinarian complete with clear written instructions for correct administration.
2) Please list anything that your dog is reactive to as well as their response (for example, ‘Coco is reactive to joggers and he will chase them and nip at their heels’ ‘Cali is reactive to men in hats and she will lunge at them in an aggressive manner barking and snapping’)/ or none: ______
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2) Con’t
______Initial: ______
3) Is your dog socialized to people? ______children? ______dogs, large? _____ dogs, small? ______
Has your dog participated in daycare? ______boarding? ______training? _____ classes? ______
Does your dog go to off leash dog parks? ______Is your dog crate trained? ______
Please describe any difficulties/issues that arose in any of the above situations: ______
______Initial: ______
4) Please describe any behaviours/psychological traits/phobias that Country Canine Care should be aware of for the sake of safety for your dog, all other canine guests, and staff of Country Canine Care (for example, chewing, nipping, biting, attempting escape, fence jumping, fear of loud noises): ______
______Initial: ______
5) Do you authorize Country Canine Care to post pictures of your dog on our Facebook page? Yes No
Do you authorize Country Canine Care to use your dog’s photo on our website? Yes No Initial: ______
6) RISKS
Please read the following information regarding potential risks and issues that may arise from enrolling your dog in Country Canine Care daycare/boarding/training/classes/services.
There are risks associated with any type of group activity. Imagine signing yourself up for soccer classes and playing soccer with a group of peers. You run the risk of twisting your ankle on the soccer field or catching a cold or the flu from a team mate. When you send your children to school, daycare or enroll them in activities they too are exposed to numerous risks on a daily basis. Injuries, accidents and illness occur as a common part of the activities that make us healthy, well rounded, people. It’s no different for your dog. If your dog stays at home alone and never goes out, the chances are that your dog will never get hurt or ill. Also, the chances are that your dog will not become a healthy, well rounded dog.
While Country Canine Care takes ever effort to avoid injuries, accidents and illness, there is a chance that your dog may experience one if not all of these risks. Please keep in mind, our own pack is enrolled
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in Country Canine Care and we are focused on the safety of our own dogs plus your dogs as if they were part of our own pack. We require proof of vaccinations from every dog owner to ensure the pack is as healthy as possible. In addition, we are experienced in recognizing signs of illness in dogs and Country Canine Care will contact owners/emergency contacts to remove a dog if illness is suspected to prevent the spread of illness. Please avoid bringing/sending a sick or injured (unless the dog is convalescing and it’s been pre-approved) dog to Country Canine Care.
If a dog is clearly ill or becomes ill during their day/stay and requires urgent or immediate medical care, they will be taken to the closest Veterinarian for care. The owner is responsible for all costs related to the Veterinarian appointment and any urgent/immediate treatment required as a result. Country Canine Care will not be responsible for any of the costs. Every effort will be made to contact the owner or the emergency contact to discuss any treatment options and associated costs.
If necessary, the dog will be transported safely to the Veterinarian by Country Canine Care and there will be no charge for the transport. If a day/stay is cut short there will be no charge for any time that the dog is not at Country Canine Care, regardless of whether or not it was already pre-booked. There will be no penalty to you – if your dog is not at Country Canine Care, you will not be charged.
If a dog is injured the same policy applies as with an illness as described above. However, if a dog causes an injury to another dog, staff at Country Canine Care or human guest of Country Canine Care the owner is financially responsible for any and all Veterinarian and Medical costs that may incur as a result of the actions of their dog. Again, please keep in mind, every effort is made by Country Canine Care to avoid risky situations that would result in such an injury, but accidents can happen in the blink of an eye even in the safest environments.
If a dog requires simple First Aid it will be administered by qualified staff at Country Canine Care. If a dog’s health deteriorates as a result from any First Aid treatment received while in our care, Country Canine Care will not be held responsible. For example, if a dog gets a minor abrasion and it’s cleansed and monitored by our staff, and that same abrasion goes on to become infected once the dog has left our care and facility, Country Canine Care will not be held responsible.
If a dog causes destruction of property, the owner will be held financially responsible. Country Canine Care believes in quality vs. quantity which results in small classes of 6 dogs or less and small daycare groups of 10 or less plus small groups of overnight guests of 5 or less, therefore supervision is close with the goal of avoiding destruction, but again incidents can happen.
In general injuries, illness, accidents and even death have the potential to occur. However, Country Canine Care is dedicated to the safe provision of day/stay care for all dogs enrolled and takes every effort to maintain a clean, sanitized, safe environment. Initial: ______
7) I agree to pay for any and all outstanding charges at the time of pick-up of my dog. Initial: ______
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8) In the event that you, your emergency contact, or any other person you have authorized to us in writing does not pick up your dog on the agreed upon pick-up date, you hereby authorize us to continue to provide boarding and any additional services at your expense. If such dog is deemed abandoned under provincial laws, Country Canine Care will use its discretion permitted by law to follow the Abandoned Pet Procedure.
Abandoned Pet Procedure:
We will attempt to contact you by phone and/or in writing, using the information that you provided, advising you that if your dog is not picked up within 7 days, your dog will be deemed to be abandoned. We will deliver your dog to a third party adoption partner, animal shelter, or we will attempt to find a new owner for your dog. We will take every effort to find the best fit for your dog’s re-homing. If you fail to pick-up your dog for any reason, you release Green Acres Hobby Farm Ltd, operating as Country Canine Care, its staff, owners, representatives, and agents from any further liability and responsibility for your dog. Initial: ______
I release Green Acres Hobby Farm Ltd., operating as Country Canine Care, its staff, owners, representatives, and agents from any and all liability which I or my dog may suffer including but not limited to injury, illness, accident, damage or death resulting from participation in daycare, overnight boarding, or outdoor trail walks.
Name: ______
Signature: ______
Date: ______
Country Canine Care staff:
Sign below to indicate you have reviewed this form plus the Country Canine Care Plan with the dog owner(s) and have proof of vaccination and flea treatment on file.
Witness: ______
Signature: ______Date:______
“Dogs are not our whole life, but they make our lives whole” Roger A. Caras
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