90 Danbury Road w New Milford, CT 06776 w
Phone (860) 799-7979 w Fax (860) 799-7980
Pet Profile
Human’s Name ______
Dog’s Name ______Dog’s predominant breed______
Gender ______Current age ______Birthday ______
Is your dog spayed or neutered? ______(All dogs 7 months and older must be spayed/neutered.)
How long have you had your dog? ______
Where did you get your dog? ______
Has your dog been socialized with other dogs? ______Frequency? ______
Under what circumstances? ______
Has your dog had formal obedience training? ______
Does your dog have any problems in the following areas? If yes, please describe
Mouthiness ______
Barking ______
Housetraining ______
Jumping ______
Has your dog ever…? If yes, please describe
Growled at someone ______
Bitten a person ______
Scaled a fence (type/height) ______
Reacted negatively when someone took food or toys away
______
Growled, snapped or bitten another dog ______
Are there any kinds of dogs your dog automatically fears or dislikes?______
Has your dog shared food, water or toys with another dog? ______
Anything else we should know or you would like to share? ______
90 Danbury Road w New Milford, CT 06776 w
Phone (860) 799-7979 w Fax (860) 799-7980
Client Information
Human’s Name ______Dog’s Name ______
Mailing Address______City/State/Zip ______
Phone (H) ______(W) ______(Cell) ______
E-mail address ______
Emergency Contact in case we cannot reach you:
Name ______Phone ______
Primary Veterinarian______Phone ______
Date of latest vaccination against (attach copy from veterinarian)
Rabies ______
DHLPP ______
Bordatella ______
Fecal exam ______
May we use an alternate veterinarian in the case of an emergency? ______
Dog’s Medical History. Please state any past or current problems and treatment.
______
Current Medication (please list reason and duration) ______
Current food and feeding schedule ______
Type and frequency of flea and tick preventative ______
How did you hear about Unleashed Doggie Daycare, LLC?
______
What services are you looking for? Example: daycare every week, daycare once in a while, boarding, etc etc:
90 Danbury Road w New Milford, CT 06776 w
Phone (860) 799-7979 w Fax (860) 799-7980
Agreement
The parties hereto agree as follows:
1). Owner represents that their dog is in all respects healthy and does not suffer from any disability, illness or condition which could affect said dog, other dogs, or staff’s safety at Unleashed Doggie Daycare, LLC (Unleashed).
2). Owner represents that their dog is non-aggressive to other dogs and people.
3). Owner agrees to provide updated vaccination and veterinary records upon request and understands that refusal to do so will prevent their dog from attending Unleashed until such records are provided.
4). Owner understands that they are solely responsible for and agree to indemnify Unleashed from all liability incurred as a result of any harm caused by their dog while attending Unleashed.
5). Owners agrees that Unleashed, their staff and volunteers, will not be held liable for any problems that develop provided reasonable care and precautions are followed, and hereby agree to release them and hold them harmless from any liability from their dog’s attendance and participation at Unleashed.
6). Owner assumes all financial responsibility for any problem that develops with their dog while at Unleashed including medical costs, destruction of equipment, materials structures or property.
7). Owner understands and agrees that dogs will be intermingled with other dogs while boarding. Crates and runs may be used at our discretion for the comfort of our entire group of dogs.
8). Owner understands that although Unleashed requires that all dogs attending are healthy and up-to-date on vaccinations, some contagious illnesses may not show symptoms that can be detected by the owners or Unleashed staff. Since the dogs are intermingling, there is a chance that your dog may contract a contagious condition such as kennel cough, puppy warts or an intestinal parasite.
9). Owner understands that Unleashed is a highly physical environment that may exacerbate pre-existing conditions such as arthritis, orthopedic issues and exercise intolerance.
10). Owner agrees to pay for services at the dog’s check-in into Unleashed. Payment is accepted in cash, check or credit card. A $25 fee will be assessed for each check returned by a financial institution.
11). Owner agrees to pick up their dog by the close of business, if the dog is picked up after the close of business the owner agrees to pay any additional charges set forth by Unleashed.
I certify that I have read and understand this agreement. I accept all the terms, conditions and statements of this agreement.
Signature of Owner ______Date: ______
Print name______Dog Name ______